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Full text of "Understanding women's depression : the roles of relationship loss and self loss"

UNDERSTANDING WOMEN'S DEPRESSION: 
THE ROLES OF RELATIONSHIP LOSS AND SELF LOSS 



By 
SARAH S. DREW 



A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL 

OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT 

OF THE REQUIREMENTS FOR THE DEGREE OF 

DOCTOR OF PHILOSOPHY 



UNIVERSITY OF FLORIDA 
1995 



LP 



Copyright 1995 
Sarah S. Drew 



For 

My Parents 

and My 

Grandmother 



Who have instilled in me both a love of leeiming and a compassion for all 

living beings. I feel blessed by their patience and by the abiding faith they 

have shown as I have journeyed along the pathway of becoming. 



ACKNOWLEDGEMENTS 

The opportunity to thank those who have contributed to the 
completion of my dissertation is truly a welcome one. I am honored to 
have worked with all five members of my doctoral committee. Each is a 
uniquely gifted individu£il, and each has made an invaluable 
contribution both to my dissertation and to my training as a 
psychologist. 

To my chairman, Dr. Harry Grater, I wiU be eternally grateful for 
my training as a therapist. In his quiet, provocative way he ignited and 
nurtured the passions of my mind. 1 will always remember fondly the 
countless hours spent discussing cases and theories and more cases. The 
tralnlQg I have received from Hainy wUl be the foundation on which I 
build my career. 

Through the entire dissertation process, from conception to final 
editing, my cochairman. Dr. Martin Heesacker, has been my Rock of 
Gibraltar. Marty has given generously of both his time and expertise. 
Even more importantly, he has patiently stood by me as I faced tidal 
waves of fear and doubt. Without exception, Marty has been available to 
gently urge me forward. His confidence in me has supported my 
substantial growth as both a scholar and scientist. 

My relationship with Dr. Robert Ziller has been a long and special 
one. Throughout my graduate school career, Bob has appeared at 
opportune moments with a warm smile and wise words of 

iv 



encouragement. His singular creativity has also served as an inspiration. 
In a discipline in which most follow the well beaten path. Bob has been 
one to consistently blaze his own trail. I salute his courage. 

As a female student in counseling psychology, I have been 
especially attentive to the women faculty with whom I have studied and 
worked. I have looked to these women as both mentors and role models- 
for lessons on professional comportment, for clues on how to integrate 
the pieces of my life. I feel deeply fortunate to have encountered Dean 
Phyllis Meek In the course of my education. Over the years, Phyllis and I 
have tateracted in a variety of different environments-classes, 
conferences, practica. In every instance, I have been impressed with her 
gentieness and with her unfailing professionalism. Phyllis has both the 
courage to speak her truth and the sensitivity to deal respectfully with 
all whom she encounters. We share a speciEil interest in and commitment 
to the issues and problems of women's lives. I would be proud to follow 
in her footsteps. 

Last, but certainly not least, I wish to thank Dr. Paul Schauble. 
Paul has been supervisor, friend, and spiritual mentor. He has been at 
my side through dark times, and valued and believed in me at points 
when I had lost faith in myself. More than anyone else, he has helped me 
along the path toward wholeness. I honor his vision, his quiet wisdom 
and strength. Paul will always have my deep love and respect. 

Numerous other friends and family members have offered me much 
needed support through the stressful process of completing my 
dissertation. My sisters, Lanier and Elizabeth, have always been there 
with WcUth words of encouragement. The knowledge of thefr loving 
presence I have carried deep within myself. Kerry has been not only my 



technical wizard, but my confidEinte and companion through much of the 
turmoil and change of graduate education. I thank him for his unceasing 
love and for teaching me how to seize the moment. Peggy, David, and 
Clyde, of the "Seminar from Hell," shared ideas and provided a safe place 
for venting. Roberta and Sandy have stood staunchly by my side, 
nurtured me through the periods of self-doubt, and respected my need for 
time and solitude. Amy has been a tireless believer in my potential emd a 
wonderfully encouraging friend. Her tangible gifts have meant more than 
I can ever say. Mary Beth has been a faithful believer in my abilities, and 
more importantly In my creative self. 1 thank her for her patience and 
unflagging confidence in my ability to spread my wings and soar. Joe 
joined me late in this process, but has played an invaluable role. I deeply 
appreciate the help he has given me in tapping the well of my own 
strength and finding the inner resources to complete this project. He has 
been earth and fire to my afr and water. And finally, I owe a deep debt of 
gratitude to Jeff whose irreverent grin and Indomitable spirit will live on 
always in my heart. 



VI 



TABLE OF CONTENTS 



page 

ACKNOWLEDGMENTS iv 

ABSTRACT ix 

CHAPTERS 

1 INTRODUCTION 1 

2 REVIEW OF LITERATURE 7 

Introduction 7 

Definitions and Incidence 7 

Explanatory Theories for Depression 13 

Psychoanalytic and Traditional Theories 13 

Relational Theories of Development 18 

Jack's Theory of Depression in Women 31 

Hypotheses 34 

3 METHODOLOGY 37 

Pzirticipants 37 

Procedures ["[ 38 

Independent Variables 33 

Dependent Variables 43 

Data Analysis ." 45 

4 RESULTS 48 

Semiple ChEiracteristics 48 

Means and Frequencies , 49 

Hypothesis Tests.. 51 

Replication of Hypothesis Tests... 52 

Ancillary Analyses 53 



vii 



5 DISCUSSION 57 

HjTXJthesis 1 57 

Hypothesis 2 58 

Hypothesis 3 59 

Sex Differences 60 

Limitations..... 61 

Strengths 63 

Suggestions for Future Research 65 

ImpUcations for Psychotherapy 68 



APPENDICES 

A INFORMED CONSENT 72 

B INSTRUCTIONS 74 

C SELECTED ITEMS FROM THE BECK DEPRESSION 

INVENTORY 75 

D SELECTED ITEMS FROM THE DEPENDENCY 

SCALE OF THE DEPRESSIVE EXPERIENCES 
QUESTIONNAIRE 76 

E SELECTED ITEMS FOR THE SILENCING THE SELF SCALE. 77 

F RELATIONSHIP LOSS QUESTIONNAIRE 78 

G DEMOGRAPHIC QUESTIONNAIRE... 80 

REFERENCES 82 

BIOGRAPHICAL SKETCH 88 



vlii 



Abstract of Dissertation Presented to the Graduate School of the 
University of Florida in Partial Fulfillment of the Requirements for the 

Degree of Doctor of Philosophy 

UNDERSTANDING WOMEN'S DEPRESSION; 
THE ROLES OF RELATIONSHIP LOSS AND SELF LOSS 

By 

Sarah S. Drew 

December 1995 

Chair: Harry A.Grater 
Cochalr: Martin Heesacker 

The purpose of this study was to explore the role of loss as a 
contributory factor in women's depression. In particular, this study 
evaluates the effects of loss of an intimate partner Eind loss of self as 
precipitcm^ts to depression. Extending the work of feminist scholars.who 
have challenged existing theories of women's depression, three models 
were evaluated. The Traditioneil Model predicts an association between 
loss of a significant relationship and depression. The "Self Loss" Model 
predicts a significant etssociation between self loss and depression; and 
finally, the Potentiation Model predicts a significant interaction between 
relationship loss and self loss on depression. Participants In the study 
were 257 female and male undergraduates who completed a relationship 
loss questionnaire, a self loss questionnaire, and two standard 
depression instruments. Results of the study and a replication both 
showed clear support for the "Self Loss" Model Eind little support for the 
alternative models. Loss of self was associated with a significantly 
greater degree of depression on both depression measures. No association 

ix 



between relationship loss, or the interaction of self and relationship loss 
was detected. Although the primary intent of this study was to expand 
knowledge regarding women's depression, the same pattern of results 
held for both men and women, thus providing insight into men's 
depression as well. Though fewer men met the criteria for depression, the 
correlation between self loss and depression still held. The 
implications of these findings for theory, reseeirch and clinical 
Intervention are discussed. 



CHAPTER 1 
INTRODUCTION 



Man's love is of m£in's life a thing apart, 

Tis woman's whole existence. 

(Byron, 1818/1958) 



There is virtually unanimous agreement among mental health 
professionals that depression is one of the most commonly occurring 
psychological disorders. According to a study by Eaton and Kessler 
(1981), approximately one out of six Americans was found to have at 
least a moderate level of depression. Furthermore, epidemiological 
studies have repeatedly and consistently shown that women are more 
likely to become depressed than men (e.g., Boyd & Weissman,1982; 
Chamey & Weissman, 1988; Eaton & Kessler, 1981). Although the actual 
statistics vary, the most conservative estimates suggest that women are 
twice as vulnerable as men to experiencing some form of depressive 
illness, at some point in their lives (Weissman & Klerman, 1987). Even 
more disturbing, recent reseeirch points to a steady increase in the 
incidence of depression, especisdly eimong younger women (Nolen- 
Hoeksema, 1990; Nolen-Hoeksema & Glrgus,1994; Scarf, 1980). 

Explanations for this sex difference in the rate of depression f£dl 
into three general categories: those focusing on biological factors, those 
targeting primEuHy personality variables, and those highlighting 
sociocultural influences. The present study will explore only the latter 

1 



2 
two categories, both of which seem criticeil to expanding our 

understanding of women's depression. {Clearly, £iny truly complete 

explEination of the causes of women's depression would have to take into 

account biological influences on mood and behavior. However, a 

biological focus was beyond the scope of the present study.) 

Predating Freud's more systematic study of the connection between 
loss and depression (or melEmcholia) by nearly two thousand years, 
human beings noted the connection between relationship loss emd 
dysphoria. Though a finer distinction is now drawn between the affects 
and behaviors that characterize the normal mourning process £ind the 
clinical symptoms of depression, the presumed link between loss and the 
onset of depression has remained strong. At present, several widely 
accepted, psychoanalyticalty bsised theories of depression are built on the 
assumption that women, in particular, are likely to become depressed in 
response to interpersonsd loss (Blatt & Zurofif, 1992; Lemer, 1988). 

Although loss has been shown to be a strong contributor to the 
onset of depression, the present study will attempt to expand the field's 
understanding of the specific role or roles loss may play. By integrating 
newly emerging theories of women's development with more established 
work on depression, the opportunity arises to deepen the field's 
knowledge of a complex disorder and to add a fi-esh perspective to the 
continuing dialogue on sex differences. 

Over the past decade, feminist theorists, such Carol Gilligan, 
Nancy Chodorow, and Jean Baker Miller and her colleagues at the Stone 
Center of Wellesley College, have challenged the view that hezilthy female 
development follows precisely the same pathway as that of healthy male 
development (Chodorow, 1978; Gilligan, 1982; Miller, 1986; Surrey, 1991). 



3 
Although these theorists and researchers have embraced some aspects of 

object relations theory, primarily the emphasis on the interpersonal 

matrix of personality development and the critical role of early parenting, 

they have questioned the portrayal of development solely as a process of 

separation from significant others (Chodorow, 1978; Miller, 1991). 

Instead, beginning with the idea that a girl's identity is formed in the 

context of identification with, rather than separation from, her mother, 

women's development is re-envisioned as "growth in connection" or 

"relationship-differentiation" (Surrey, 1991, p.36). In other words, the 

construction of a self is hypothesized to be a different process in women 

and men and to result in a different developmental endpoint. For women, 

whose developmental pathway Includes lifelong identification with the 

mother, the maintenance of a number of emotioneilly intimate 

relationships is seen by these scholars as critical to emotionEil well-being 

and to the sustaining of a strong sense of identity over the entire 

lifespan. In contrast, the developmental pathway of men demands early 

differentiation from the mother in order for identification with the father 

to take place. As a consequence of this special demand, men become 

increasingly more separate and autonomous as they mature, and are 

assumed to be less invested in relationships, at least with regard to their 

sense of identity. 

If one begins with the proposition that relationships are more 

central to a healthy identity or sense of self in women than in men, then 

clearly a number of possibilities for understanding the high incidence of 

women's depression follow. It might be plausible, for example, to Just 

accept the proposed link between depression and the loss of a significant 

relationship, and to understand the sex difference in rates of depression 



4 
as a function of the differential Importance of high quality relationships 

to a strong sense of Identity In women. Alternatively, Jack (1991) has 

offered the provocative conceptualization that depression In women may 

be more a response to loss of a self, In the context of a relationship, 

than to the loss of a significant relationship. She has Indicated that, 

"women's vulnerability to depression does not lie in their 'dependence' on 

relationships . . . but on what happens to them within their 

relationships" (p. 21). Yet another possibility for understanding women's 

depression lies in investigating the combined effects of self loss and other 

loss. The effects of each of these types of loss are investigated in this 

study. 

In 1991, Jack published a study that employed a simple, but 

powerful approach to understanding women's subjective exp)erience of 

depression, a study that may ultimately also prove useful in 

understanding the sex difference in this disorder. Rather than rel5^g on 

existing theories of depression, Jack chose to use depressed women as 

her "guides" and took a stance assuming that these women were fuUy 

capable of conveying their own experiences. Based on ceireful analysis of 

individual Interviews with 12 women previously diagnosed with major 

depression or dysthymia; Jack identified a theme common to many of 

these women, a theme that she labeled "loss of self." Somehow in the 

context of caring for others, women noted that they had lost a strong 

sense of themselves and were aware of feeling disconnected fi-om their 

own needs, wishes, tadents, and emotions. For these same women, when 

a core relationship such as a msirriage failed, "the sense of hopelessness 

and helplessness seemed to stem from despair about the possibility of 

bringing their own needs and initiative into their relationships," rather 



than arising simply as a reaction to the loss of the other (Jack, 1991, 
p.28). 

Based on this perspective, one of the likely reasons for women's 
greater vulnerability to depression becomes clear. Without giving up 
Freud's conception of optimal adult functioning as residing in the 
capacity to love and to work, one can reasonably speculate that healthy 
intimacy is more fundamental to a woman's sense of self and competency 
than to a man's. Because of this potential difference, women's self- 
evaluation's are strongly tied to their ability to form and maintain high- 
quality attachments. When relationship loss occurs, women become 
especially prone to varying degrees of depression, depending on the 
significance of the loss, and the extent to which she has sacrificed her 
own identity in an attempt to maintain the connection. 

Incorporating Jack's idea that loss of a clearly defined sense of self 
is central to women's depression, the current study Avill also test two 
other predictions concerning loss of an intimate relationship. Using 
young adults who have experienced a recent breakup, three models wiD 
be compared. The first model tests the traditional psychoanalytic 
assumption that loss of a significant relationship is associated with 
depression. The second model focuses on the association between loss of 
self and depression. And, the third model looks at the combined effects of 
loss of a relationship Eind loss of self on depression. 

This is a study about the importance of self loss and relationship 
loss as they contribute to the development of depression and to its degree 
of severity . As previously mentioned, depression is a highly debilitating 
disorder. Though varying to chronicity and severity, fi-om individual to 



I 

6 
Individual, depression almost always permeates all aspects of 

functioning, generally disrupting both social and occupational 

functioning and causing significant suffering Although most theories of 

depression acknowledge the important role of loss, the present study 

attempts to replicate, extend, and refine the field's understanding of this 

connection. An expanded understanding of the disorder could potentially 

lead to improved prevention and treatment efforts. 



CHAPTER 2 
REVIEW OF THE LITERATURE 



In attempting to navigate the delicate balance between the T and 
the "we," women frequently sacrifice the "I" in the service of 
"togetherness," thus assuming a "de-selfed" position in 
relationships. Depression may result from the sacrifice of self and 
the concomitant loss of self-esteem, which accompanies the 
unconscious awareness of self-betrayal. (Lemer,1988, p. 227) 

Introduction 



As might be expected beised on the scope of the problem, the 
existing literature on depression is voluminous. Therefore, this chapter 
will focus only on the most relevant material. Initially, Information on 
diagnosis and incidence wUl be discussed. Next relevant theories of 
depression will be covered, including a look at psychodynamlc theories 
and at newer theories of women's development. Flnalfy, Jack's research 
and conceptualization of women's depression wUl be reviewed as it 
applies to the current study. 

Definitions and Incidence 

The fourth edition of the Diagnostic and Statistical Manual of 
Mental Disorders f 19941. published by the American Psychiatric 
Association, devotes an entire section exclusively to the "mood disorders" 
including the Depressive Disorders, the Bipolar Disorders, and two 
additional disorders that are named according to etiology, i.e.. Mood 
Disorder Due to a General Medical Condition and Substance-Induced 
Mood Disorder. Also Included in the section on mood disorders Eu^e 



8 
descriptions of mood "episodes." According to the newest classification 

system, these episodes are defined as the building blocks of mood 

disorders, but are not diagnosable as independent entities. Included in 

the newly refined category of mood episodes are the following: Major 

Depressive Episode, Msinic Episode, Mixed Episode, and Hypomanic 

Episode. 

The extensive and expanded coverage of the mood disorders 

in the DSM-IV is yet another indicator of the prevalence of mood or 

affective disorders. In feict, there is widespread agreement within the 

medical/ psychologic£il community that depressive sjonptoms are the 

most common problem encountered in clinical practice { Keller, 1988; 

Paykel,1982). Epidemiologists Chamey and Weissman (1988) have 

estimated that some degree of depression is currently £iffecting between 

10 and 14 million Americans. Furthermore, after reviewing data from 

several recent large-scale National Institute of Mental Health studies on 

depressive illness, these same epidemiologists concluded that the lifetime 

risk for men of experiencing "nonbipolar" depression was 7-12% and for 

women was 20-25%. A recent article in Time reported that "rates of 

depression have been doubling in some industrlad countries roughly every 

10 years" (Wright, 1995, p 52). 

Rush (1982; p.l) noted that approximately 1 in 200 depressed 

Individuals kiU themselves and that suicide is now the second leading 

cause of death in the adolescent population. For young adults, suicide is 

the third leading cause of death following traffic accidents and homicides 

(Wright, 1995). Given the strong connection between depression and 

suicide, these numbers clearly Indicate the profound significance of the 

problem of affective illnesses, and the pressing need to improve 



9 

understanding and treatment for those Individuals experiencing even the 

mildest forms of these disorders (Hirschfleld & Davidson, 1988). 

Though bipolar or mixed forms of mood disorder are significant 
clinical problems, the focus of the present work is solely on the 
depressive end of the spectrum. Subsumed under the general heading of 
depressive disorders are Major Depressive Disorder, Dysthymic Disorder, 
and Depressive Disorder Not Otherwise Specified. In addition, for the 
purposes this study, the presence of at least several fundamental 
depressive sjnnptoms such as pervasive sadness or strong feelings of 
helplessness, will be considered relevant. These types of symptoms are 
often found in conjunction with adjustment disorders or bereavement 
reactions. In these instances, symptoms may be may be less intense and 
enduring, than with major depression, but still cause deep subjective 
pain or a marked shift downward fi-om typical levels of social or 
occupational ftinctionlng. 

According to DSM-IV (1994), Depressive Disorders or Episodes are 
definable by both inclusion and exclusion criteria. Looking first at 
exclusion criteria, depressive Illnesses are distinguishable by the absence 
of any history of mania. Second depressive disorders are delineated by 
the lack of a clear connection between depressive symptomology and a 
medical illness, or depressive symptomology and the use or abuse of 
certain substances. In addition, during the diagnostic process, subtypes 
of Schizoaffective Disorders, Schizophrenia, Schizophreniform Disorder, 
subtypes of Delusional Disorders, and Psychotic Disorders Not Otherwise 
Specified must be ruled out as the primary syndromes. Finally, 
uncomplicated bereavement must also be ruled out as an explanation for 
^nnptoms. 



10 
Turning to inclusion criteria, Depressive Episodes are identifiable 

by the presence, over at least a two-week period, of either pervasive 

feelings of sadness or emptiness, or by lack of interest or pleasure in 

normal activities. In addition to depressed mood or anhedonia, at least 

four of the following must also be noted : substantiad weight loss or gain, 

or chemge in appetite; insomnia or hypersomnia; observable psychomotor 

retEirdation or agitation; lowered energy levels or chronic fatigue; 

excessive feelings of worthlessness or guilt; diminished cognitive 

abilities; recurrent thoughts of suicide or death, a plan to commit 

suicide, or an actual suicide attempt. To fully meet the criteria for a 

depressive episode, the core s5raiptoms outlined above must also bring 

about subjective or objective Impairment in critical areais of functioning, 

such as work and Interpersongd relations. S5miptoms are most often 

noted to occur on a dally or near dally basis. 

Although the presence of specific symptomotology is necessary to 

the diagnosis of Depressive Disorders, accurate knowledge of the 

duration of identified problems is edso required. As mentioned previously, 

hi order to meet the criteria for a major depressive episode, five of the 

symptoms outlined above must have been present during the sEime two 

week period. As a further refinement in the the diagnosing of a Major 

Depressive Disorder, the disorder is designated as a single episode or as 

recurrent. In the event that all S5Tnptom criteria are met for two full 

years, an episode of major depression may be labeled chronic. Similarly, 

Dysth3miic Disorder, though generally less debilitating than a major 

depressive episode or disorder is by definition a chronic form of 

depression and is hi part identified by the persistence of depressed mood 

over a two year span. 



11 

Diagnoses of Depressive Disorders may be further refined by 
reference to "specifiers describing the most recent episode." These 
specifiers include level of severity (mild, moderate, or severe) of the 
episode, and the presence or absence of psychotic features. In CEises that 
no longer meet all criteria for a Depressive Episode, it may be assessed as 
in either partial or ftill remission. The final group of specifiers includes 
criteria for chronicity, catatonic features, melancholic features, atypical 
features, postpartum onset, longitudinal course, and seasonal pattern of 
the Depressive Disorders. 

Extensive research on risk factors for depression h£LS looked at 
such differences as sex, age, social class, race, urb£in or rural habitation, 
and marit£d status. Overall, these studies have produced few clear 
results. For example, sQthough there has been much speculation on the 
relationship between life stzige and the risk of depression, the results in 
this area are contradictory and confusing. Only the work on birth cohort 
(with cohorts defined by decade of birth) and depression seems to 
indicate a verifiable trend toward an increasing incidence of depression 
begmning in the 1940s (Goldin & Gershon,1988; Kessler et al.,1993). 
There is some evidence that those fi-om lower socioeconomic classes are 
more likely to become depressed. Also, some studies have suggested that 
individuals who are separated or divorced are at greater risk for becoming 
depressed. However, these findings are far fi-om conclusive. In fact, some 
of the research on marital status and susceptibility to depression seems 
to vary with the sex of the participants (Boyd & Welssman, 1982). For 
example, women and men who have never been married are often found 
to have approximately equal rates of depression, while women who are 
married, separated, or divorced aie found to have higher rates of 



12 
depression than men in those same categories. Finally, recently widowed 

men tend to be more depressed than recently widowed women. 

In contrast to the genercilly inconclusive findings on risk factors 
for unipK)lar depression, there is substantial research evidence for a sex 
difference in the firequency rates of the disorder, with women on the 
average, betag twice as likely as men to become depressed ( Kessler, 
McGonagle, Swartz, Blazer, & Nelson, 1993 ). Though in comparing rates 
of mentsd illness in genersd neither sex appears to be at greater risk, 
there are a number of studies showing that specific tjrpes of 
psychopathology occur with greater frequency in one sex or the other 
(Cox & RadlofF,1984). For example the sex difference In depression has 
been found consistently over approximately the last forty years, in both 
clinical and epidemiologic studies, and across the continuum of 
depressive illness from mild depressive symptoms to clinically diagnosed 
major depression (American Psychiatric Association, 1994; Boyd & 
Welssman, 1982; Goodwin & Blehar, 1993; Nolen-Hoeksema, 1990; Scarf, 
1980; Welssman & Klerman, 1987). Additionally, the 2:1 female to male 
ratio has been found to hold fairly constant in international studies on 
unipolar depression (Welssman et al.,1993). Findings for bipolar forms of 
mood disorder generally Indicate fsiirly equal incidence rates in men and 
women, though even in this Instance, the actual course of the disorder 
may vary In sex specific ways. 

Depression Is a costly disorder. In its most severe forms, an 
individual may feel completely Incapacitated and unable to function, 
even at the level of performing basic self- care activities. More commonly, 
the effects of depression are relatively subtle but may still significantly 
Interfere with Interpersonal functioning and with the ability to maintain 



13 



adequate work performance. In addition, depressive disorders cause 
incalculable subjective p£iin in the form of intense feelings of guilt, 
worthlessness, hopelessness, and sadness. According to Keller (1988), 
even though "depression is the most widespread of all the major mental 
illnesses... [and] despite the potential morbidity and lethality... 
depression is often underrecognized, underdiagnosed, and undertreated" 
(p. 280). 

In summary, the general category of mood disorders may be broken 
down into the bipolar disorders, which are defined by the occurrence of 
at least one manic episode, and the depressive disorders, which are 
defined by the presence over at least a two-week period of dysphoria or 
anhedonia. The present study is solely concerned with the depressive 
disorders. However, even with this narrowed focus, estimates of lifetime 
prevalence risks for a major depressive episode range from 2.1 — 12.3% in 
men and 4.7 — 25.8% in women. Prevedence estimates that included 
milder or more chronic manifestations of depression would swell these 
figures even further. 

Explanatorv Theories for Depression 

Psvchoanalvtic or Traditional Theories 

Despite the very high incidence of depression, relatively little is 
known about Its etiology. Some types of depression appear to be more 
endogenous or biologically mediated, while others appear to be more 
situationally mediated. Preliminary evidence for a genetic component in 
major depression has been based on the increased risk of contracting the 
disorder found in first-degree biological relatives. In comparison to the 



14 
general population, the risk of experiencing at least one clinically 

significant depressive episode is increased between 1.5 and three times. 

There is also some increased risk of dysthjonic disorder in the first degree 

biological relatives of those di£ignosed with major depression (American 

Psychiatric Association, 1994). However, the existence of a familial 

pattern alone is not sufficient to establish a genetic contribution. Twin 

and adoption studies which compare the incidence of depression in 

monozygotic and dizygotic pEiirs have allowed for a clearer look at genetic 

contribution. WhUe these studies have established a substantial genetic 

contribution to bipolar forms of depression, findings regarding unipolar 

depression are much less definite (Boyd & Weissm£in,1982; Chamey & 

Weissman,1988). As the disciplines of genetics and biological psychiatry 

become increasingly sophisticated, it is likely that specific research 

findings will £ild in understanding the etiology of some types of depressive 

disorder. In the interim.personality and situational factors will continue 

to be of interest. 

WhUe fuUy acknowledging the input of genetic factors, the current 

study focuses on the contributions of one type of environmentEil or 

situational input to the development of depressive illness. In particular, 

the higher incidence of depression in women leads to a reconsideration of 

the presumed effect of interpersonal loss as an adequate explanation for 

this sex difference. As Kaplan (1991) has suggested, it is important to 

look at not just individuEil personality, but at "personality structures 

that may be common to the group of people most likely to become 

depressed, that is, women" (p. 267). The current study attempts to look 

at and compare the effect of loss on the development of depression in 

both women and men. 



15 

Beginning with Sigmund Freud, the role of loss In depression 

became firmly established. In his 1917 work, Mourning and Melancholia . 
Freud identified both mourning and melancholia as responses to loss. 
However, he defined only melancholia — what would currently be labeled 
depression — as pathological. Accordmg to Harris (1987), Freud's 
definition of melancholia, in contrast to mourning, included a lowering 
of self-esteem. Those individuals most vulnerable to depression were 
assumed to be "orally fixated," and therefore more needy and dependent. 
Although Harris denied that the traditional psychoanalytic model is 
explicitly gender -biased, she does concede that the underlying 
developmental model, in which girls £ind women are believed to have 
impaired self-esteem, due to anatomical inferiority, could imply greater 
proneness to depression. 

Object relations theory also focuses on the connection between 
loss and depression, not only in terms of the actual loss, but also in 
terms of the the individual's internal object world and developmental 
level. As Marcus explains "an object relations theory of depression shifts 
the emphasis from the external precipitant (e.g., actual loss) to its 
psychological significance vis-a-vis internalized object relations" (1987, 
p. 27). For object relations proponents, much of the current 
understanding of the significance of sex in etiology of depression is based 
on the work of Sidney Blatt and associates (Blatt, 1974; Blatt, D'Afflitti, 
& Quinlan, 1976; Chevron, Quinlan, & Blatt, 1978). 

Though Melanie Klein was the first to elucidate a criticed link 
between depression and internalized object relations, Blatt among others 
has built on her theorizing. According to Marcus, he postulates that 
"object representations initially grow out of repeated experiences of 



16 

frustration and gratification with a consistent and need gratifying object" 

(1987; p. 29). As development proceeds and the child differentiates, 
internal representations are thought to become more accurate and 
stable. However, if early parenting is inadequate, the Integration process 
is disrupted, with negative consequences for later functioning. 

Based on his particular developmental model, Blatt proposed that 
there are two types of depression, in addition, he speculated that "not 
only is the predisposition to depression determined by a failure to 
establish adequate levels of object representation, but also that the level 
at which the object is represented is related to the type of depression" 
(Marcus, 1987, p. 29). In the case of "anaclitic" depression, the object is 
represented at a very primitive level and the loss of the object is 
experienced £is threatening basic survival. This type of depression can be 
recognized by the "desperate object seeking behavior of the individual," 
who may make "exaggerated or distorted attempts to maintain satisfying 
interpersonal experiences." Introjective depression, by contrast, was 
defined as Indicating a more advanced level of functioning. This second 
type of depression was thought to refiect "the Individual's fears, not 
about losing the object per se, but about losing the love, acceptance and 
approval offered by the object." In introjective depression, observers 
might note a perfectionistic and excessively self-critical style, which by 
the logic of this theory is based on an attempt to create a stronger and 
more positive sense of identity. 

As thefr work progressed, Blatt and colleagues (Blatt & Schichmen, 
1983; Blatt & Zuroff, 1992) expanded their conception of anaclitic and 
introjective depression to create a broader theory of psychopathology, 
that Included "two configurations of psychopathology." The first 



17 
configuration was based on the anaclltic line of development, that is, 

primEirily on distorted Interpersonal relationships. The second 

configuration, or introjective line of development, involved exaggerated 

attempts to consolidate a strong sense of self. According to this 

theoretical position, women were believed to manifest anaclitic pathology 

more often, and men to manifest introjective pathology. Explanations for 

this difference were rooted in the differing demainds on females and males 

to find primary objects for affection and identification. 

If women are more prone to anaclitic depressions, this would 
imply, within the object relations fi-amework, that there are sex 
differences in the developmental process. The pheise of development that 
has been most scrutinized in this regard is the separation-tndividuation 
phase. Differentiation from the primary caretaker begins during this 
phase Eind the first steps toward the establishment of identity and object 
constancy are undertziken. Chodorow (1978) has suggested that the "pre- 
oedipal period is more protracted in women" and other researchers have 
discussed the appsirent difficulties that female children seem to 
encounter in negotiating the rapprochement subphase of separation. As 
mentioned above, Blatt and ShichmEin (1983) explained this difference in 
women £ind men by pointing to the need of young girls to separate 
successfuUy from their mothers. This is considered a more complex 
process than that required of male children who eire biologically different 
fi-om their mothers £ind, ff not successfully negotiated, blocks the 
developmental process. 

In their most recent work, Blatt and Hers (1993) have focused on a 
phenomenological approach to understanding both the self sind the 
subtypes of depression. From this perspective, in which the sense of self 



18 

is seen as primarily subjective, the self is defined as "the locus of 

affective experience (1 feel), the source of a sense of agency (I do), and the 
basis for a sense of self-awareness and self-reflectivity (I am)" (p. 173). 
They propose a revised theory of self-development that integrates object 
relations theory with phenomenological findings on the self. Three 
developmental stages are identified: the rudimentary self, the introjected 
self, and the mature self reflecting progressively more advanced levels of 
ftinctioning. Types of depression in this model are distinguished on the 
basis of precipitating life events and are characterized as either 
disruption of gratifying interpersonal relationships or disruption of an 
effective, essentially positive sense of self. Differing symptom clusters or 
patterns typify the two types of depression and Unk them to the 
rudimentary or introjective level of functioning as evidenced in subjective 
expressions of the self. Those at the mature level of development are seen 
as less prone to depression. 

Segal and Murran (1993), in their response to Blatt and Bers, first 
point out that the higher rate of depression hi women is not completely 
addressed by the theory— -a noteworthy omission. Second, they chaUenge 
the strong emphasis on early parenting as the primary influence on the 
chfld's self. They draw attention to the work of GiUlgan (1982,1989), as 
an example of research that emphasizes the importance of other factors, 
such as peer relationships during adolescence and gender role demands 
in the shaping of "self-identity." 

RelationeJ Theories of Development 

GUligan's 1982 book In a Different Voice ushered in a whole new 
era of thinking about women's development. Though a number of other 



19 
theorists had also been instrumental in this newly emerging psychology 

of women (See for example Chodorow,1978, Miller,1976, & Schaef,1981), 

Gilligan's work fully focused the attention of academics, and, to a lesser 

extent, the general public, on differences between men and women. 

Although this emphasis on differences was not, in eind of itself, unique, 

GiUlgan presented them in such a way that women were characterized, 

not as weak or pathological but, as having strengths and abilities that 

had been all but invisible to the field of psychology and undervalued by 

the culture as a whole. In a study focusing on moral reasoning, women's 

ethic of care was seen as a vcdid alternative or counterpart to the 

traditional, patriarchal ethic of justice, with one ethic emphasizing 

relationship and the other ethic emphasizing separateness or 

indivlduaility. In the conclusion to In a Different Voice . Gilligan asserted 

that "the silence of women in the narrative of adult development distorts 

the conception of its steiges and sequence" (p. 156), and she invites the 

continued exploration of women's voices and lives. 

This exploration of the psychology of women and women's 
development has indeed progressed and is typified by both GiUigan's 
ongoing studies £md by the research ceirried out at the Stone Center of 
Wellesley CoUege. During the past decade Gilligan and her coUeagues at 
the Harvard Project on Women's Psychology and Girl's Development have 
carried out several longitudinal studies aimed at mapping female 
development more accurately (Gilligan, Lyons, & Hamner, 1991; Brown & 
Gilligan, 1992). 

One study was conducted over a three-year period at a private 
school for girls in New York and was an attempt to take an in-depth look 
at female adolescent development and to clarify differences between 



20 
males and females in the existence and development of a relationally 

defined self (Gilligan, Lyons, & Hamner,1991). Adolescence was targeted 

for study as both a critical phase of growth and as a period when gtrls 

are at high risk for losmg a sense of their own identity. 

Twenty-three girls were interviewed once per year over a three year 

period. These girls were asked to respond to the question, "How would 

you describe yourself to yourself?" The goal of the interviews was to 

clarify the conflict between existing theories of a separation- 

individuation and newer speculations about the centrality of close 

relationships in the lives of women and girls throughout the lifespan. In 

previous work feminist scholars had theorized that identity development 

in girls did not necessarily Involve separation from significant others but 

did reflect a change or differentiation process within the context of key 

relationships. Study results revesded a number of themes common in the 

girls' self-descriptions. Themes focusing on a sense of self in 

relationships were by far the most frequent, with themes of independence 

occurring only one-fourth as often — suggesting a tendency, though not 

an exclusive one, for girls to define themselves relationally. Clearly, 

independence or sepEiration was also valued by the gfrls, but seemed to 

be defined more in terms of "renegotiating and reframlng of relationships 

in light of thefr new ability to consider the other person" {p. 85). To 

reiterate then, if gfrls defined independence as an increased capacity to 

meet thefr own needs, this in turn decreased dependence and allowed for 

cm improved ability to understand others and to buUd higher quality 

relationships. These results offer support for the the concept of a 

relational self and pose a challenge to existmg concepts of the self, 

including the equation of psychological maturity with self- autonomy. 



21 

Continuing and expanding the work of the Harvard Project, Brown 

and Gilligan (1992) conducted yet another longitudinal study at the 
Laurel School in Cleveland, Ohio. This study culminated in the 
publication of their book Meetings at the Crossroads, a description of the 
development of girls between the ages of 7 and 18 years old. Again, the 
primsiry goal of this study was to demystify the changes that have been 
documented to occur in girls during the period between approximately 
twelve and sixteen years, but to include the voices of younger girls as a 
way of pinpointing specific shifts or changes. 

Early adolescence can be conceptualized as a crossroads between 
girlhood and womanhood, a time of great significance in female 
development. Although there Eire numerous studies documenting the 
dramatic changes that commonly occur in teenage girls between ages 
approximately 12 and 16 years old — including declines in l.Q. scores £ind 
poorer academic performgince in math and science, decreased risk-taking 
and self-confidence, and sharp increases in rates of body-image 
disturbance, depression, and suicidal ideation — there have been no 
comprehensive explanations for these changes (Pipher, 1994; 
Uzelac,1995). 

Listening closely to the girls. Brown Eind Gilligan (1992) have 
begun the process of accounting for these chsuiges. In the Laurel School 
project, for example a striking contrast was noted between the clear, 
strong voice of girlhood and the confused and fesirful voice of the 
adolescent who all-too-often silenced her own thoughts and feelings. 
Describing this shift as a relational impasse, the researchers noted a 
number of commonly occurring disconnections or dissociations "between 
psyche and body, voice and desire, thoughts and feehngs, self and 



22 



relationship" (p. 7). These changes as a whole were labeled as the giving 
up of authentic relationship to an idealized concept of relationship 
grounded in a feminine ideal of perfection and self-sacrifice. Not 
surprisingly, the self-silencing behaviors were noted to have profound 
effects on the adolescent girls' relationships to self and others, and to 
their ability to function effectively in the world. 

Both complementing and extending the work of Gilligan and the 
Harvard Project is the work of Jean Baker Miller and her colleagues at 
the Stone Center of Wellesley CoUege. In her provocative work Toward a 
New Psychology of Women (1976, 2nd ed.l986), Miller, like Gilligan, 
questioned the psychological tradition of assuming man as the measure 
of all things, a tradition that she has indicated probably renders an 
incomplete vision of human nature. She recommended looking "toward a 
more accurate understanding of women's psychology as it arises out of 
women's experience" (1986, p.49) and stressed the necessity of 
understanding women's behavior, strengths, and difBculties in the 
context of an oppressive patriarchal culture. 

Once again, paralleling Gilligan, Miller's theory focuses on the 
concepts of self and relationship. She used the idea of an alternative 
developmental pathway and outcome to de-pathologize women's 
priorities, needs, and behavior. Similar to Tavris (1992), who has 
pointedly observed that "when men have problems, society tends to look 
outward for explanations; when women have problems, society looks 
inward" (p. 175), Miller did not focus immediately on intrapsychic 
explsmations for problems. Instead, she turned to women's gender role 
training as a primary source for understanding the prevgQence of such 
difBculties as low-self-esteem and depression. 



23 
Comparing male and female gender role training, Miller states that 

from early in life men are rewarded for being active and rational, while 
women are rewarded for being sensitive and emotionally attuned to 
others. This leads hi turn to the development of differing core 
identities — doing, for men, and giving, for women — and to differing 
vulnerabihties and strengths. 

For over ten years now, this theme of differences between men and 
women has been the focus of extensive study at the Stone Center for 
Developmental Services and Studies. The center is afOQlated with 
WeUesley College and has served as a sort of "thhik tank" for cUniclans 
and scholars who have interests hi the psychology of women. According 
to Peay, "psychology and feminism, like the twin spirals of a double 
heUx, have interacted to produce new theories in both fields" (1994, p. 
22). What has emerged from the Stone Center, and in the work of the 
Harvard Project, has been labeled difference feminism (Kamlner, 1993). 
"Difference" feminists, unlike "equal rights" feminists, have tended to 
acknowledge rather than debate differences between men and women. 
Having moved beyond thefr original goal of questionhig psychoanalj^c 
formulations that "have tended to portray women as too emotional, too 
dependent, and lacking clear boundaries" (Jordan, Kaplan Miller, Stiver, 
& Surrey, 1991, p.v), difference femhilsts have Identified and celebrated 
what they see as women's superior strengths in the areas of nurturing 
skills and relational capacities. 

Writings from the Stone Center, published in the form of "working 
papers," began hi the early 1980s with a new delineation of female 
development. Surrey (1991) expUcated the construct of the "self-hi- 
relation" as cin alternative to the contemporary emphasis on the 



24 
autonomous self "as an orgEinizing principle in human development" (p. 

51). Drawing on the theories of Miller (1986) and Gilligan {1982), she 

proposed that women's primary sense of self is relational, hence the term 

self-in-relation. The working definition of self underlying her approach is 

of self as "a construct useful in describing the organization of a person's 

experience and construction of reality that illuminates the purpose and 

directionality of his or her behavior" (p.52). In contrast to the primary 

emphasis in the writings of Mahler, Erikson and Levinson on separation 

as necessary to the establishment of healthy identity, Surrey postulated 

that capacities such as autonomy and creativity, accepted hallmarks of a 

mature self, develop within the context primary relationships. 

The mother -daughter relationship is offered as the beginning point 

in the female's alternative developmental pathway. This relationship, in 

which sharing of feelings between mother and daughter Is encouraged 

and reinforced, is thought to be "the origin of the capacity for empathy 

and the beginning practice of relationgd development" (Surrey, 1991, 

p.55). In outlining this theory of women's development, Surrey 

emphasizes three important aspects of the mother -daughter relationship: 

the child's Interest in and desire for emotional connection to the mother, 

the child's evolving abihty for mutuEil expression of empathy, and flnEilly 

the development of a capacity for "mutual empowerment" (p.56). Mutual 

empowerment denotes a feeling hi both mother 2m.d daughter of 

interperson£il efficacy, of confidence In perceiving, responding and 

relating to the feelings of others. This empowerment is based on the open 

exchemge of feelings and the ability to be with or understand the other. 

"Mothers help to empower their daughters by allowing them to feel 

successful at understanding and giving support at whatever level is 



25 
appropriate" for their age (p. 57). The development of healthy self-esteem 

is another outgrowth of mutual empowerment. Good relationships — 

those based on mutual understeinding and regard — become fundamental 

to a sense of worth. Women learn to value their ability both to take care 

of others and to take care of the relationships between themselves and 

others. 

Summarizing the elements of the "core self in women, Surrey 

emphasized: (1) "an interest hi and attention to the other person(s), 

which form the base for the emotional connection and the ability to 

empathize with the other(s); (2) the expectation of a mutual empathic 

process where the sharing of experience leads to a heightened 

development of self and other; and (3) the expectation of interaction and 

relationship as a process of mutual sensitivity and mutual responsibility 

that provides the stimulus for the growth of empowerment and self - 

knowledge" (1991, pp. 58-59). She was careful to distinguish this 

alternative developmental pathway of women from that of separation- 

individuatlon and labels the evolution of the femsde self as a process of 

"relationship-differentiation" (p. 60). In defining " relationship 

differentiation," Surrey used the analogy of embiyological development 

with the self becoming increasingly complex within the context of I 

connection to significant others. According to this perspective, a two-way i 

I 
model of Interaction, identity and the capacity for relationship grow 

hand in hand from the child's earliest attempts at mutuality to the f 

much richer and more complex forms of adult relating, but the 

importance of the give and take of intimate shciring or interaction never 

declines. 

In addition to Miller and Surrey, other Stone Center theorists, f 



26 

such as Jordan, Kaplan, and Stiver (1991) have elaborated on this model 

of the self-in-relation, focusing on specific topics such as empathy, 
dependency, and mutuality, or on the applications of this model to 
treatment of disorders such as depression, eating problems, and work 
Inhibitions in women. Jordan has reconstrued empathy as a strength 
arising from the identification process between mother £ind daughter, 
rather than eis a form of regressive merging indicative of poor self- 
boundaries. Citing Kohut's 1978 definition of empathy as "a 
fundamental mode of human relating" (pp. 704-705), Jordan (1991) 
argues that empathy as a relational capacity is far from primitive but is 
in fact rooted in a well-difierentiated self with high levels of ego strength 
and flexible ego boundaries. Stiver has offered a new view of the concept 
of dependency, a view that turns more on the idea of mutual support or 
interdependence as a healthy aspect of adult ftinctioning. Noting the 
long-held pairing of dependency with primitive oral needs, she has 
challenged the idea that "to need anything in adulthood is regressive" 
(1991, p. 146) and has suggested that the continued growth in adulthood 
of both women and men is predicated on the ability to share feelings, 
needs, and vulnerabilities without shame. 

Both Jordan and Stiver have addressed the frequency of depression 
in women. Jordan has linked women's depression to either 
overidentification with others or to poorly developed self-empathy. 
Alternatively, Stiver called attention to the constraints on women that 
limit the expression of their inner most needs and the link between the 
silencing of these needs and depression. 

Of the Stone Center Staff, however, it is Kaplan (1991) who has 
explored the topic of women's depression in the most depth. She began 



27 
by reiterating the higher Incidence of depression in women, drawing from 

other writers to describe personality characteristics often associated with 
depression, such as a need to please others and difficulty In attending to 
or expressing the self (Arieti & Bemporad, 1978). Agreeing with Arletl and 
Bemporad that these characteristics are indeed found more often in 
women, and again noting the much higher incidence of depression in 
women, Kaplan (1991) suggested that depression may be "not an 'illness' 
superimposed on an aUen or Indifferent personality, but rather may be a 
distortion — an exEiggeration of the normal state of being female in 
Western society" (p. 207). BuUding on this idea, Kaplan then moved on 
to examine "the fundamental overlap between central dynamics of 
depression and key dimensions in the nature of women's psychological 
development (p.207). In distinguishing her approach, Kaplan emphasized 
that whereas others have advocated the necessity of looking at individual 
personality as a means for understanding depression, she has argued for 
identifying personality structures that may be common to those most 
likely to become depressed— women. Furthermore, though maintaining a 
focus on personality, Kaplan has Included the role of the social context 
as a shaping force. 

In a brief survey of factors long held as causes or precipitants of 
depression, Kaplan (1991) has Included the experience of loss, the 
inhibition of anger and aggression, the inhibition of action or 
assertiveness and low self-esteem. She has asserted that these factors 
have not been adequately studied relative to their influence on 
depression and their link to sex or gender and goes on to suggest that 
this is a major oversight in the literature. Expanding on the relevance of 
loss, Kaplan has suggested that women experience significant feelings of 



28 
loss each time they seek, but fail to make, a mutually empathic 

connection with another person. From the perspective of self-in-relation 

theory, the experience of this type of loss is critical for two reasons. 

First, it undermines a woman's "core self-structure as one that can 

facilitate reciprocity and affective connection in relationships" (Kaplan, 

1991, p.211). Second, given the contemporary cultural climate, which 

does not place a high value on relational capacities, women may fail to 

value these abilities as strengths. In this framework, depressed women 

are assumed to have responded especially strongly to loss of an 

opportunity for mutual understanding and expression of self, rather than 

the loss of the gratification provided by another. Kaplan has also viewed 

some inhibition of anger and aggression as normative in women because 

of the possibility of anger and aggression disrupting valued relationships. 

For depressed women, tliis pattern is, again, assumed to be exaggerated, 

thus leading to disempowerment. 

Inhibition of action and of assertiveness is seen as one potential 

consequence of women's perceived failure to form mutuaUy afiBrming 

connections. In a selective way, women who are feeling disconnected 

from others may blame themselves for this disconnection and may work 

even harder to improve the relationship or to act on behalf of the other 

person. At the same time, however, these women may reduce activities on 

their own behalf, thus narrowing thefr lives and leading to a greater 

vulnerability to depression. Low self-esteem in "normal" women can be 

understood, in part, as a response to the cultural standards against 

which women measure themselves; standards that support autonomy 

and individualism, rather than empathy and cooperation. For women 

who are depressed, Kaplan has hypothesized that numerous or early 



29 

experiences of emotional disconnection lead to a damaged sense of self 

and a woman's fear of her own destructiveness, a fear that arises from 
taking responsibility for past relationship failures. 

Using the self-in-relation theory to understand female 
development, Kaplan explicates the points of divergence from existing 
theories of depression, and In particular from psychoanal3rtic 
perspectives. Although both self-ln-relatlon-theory and psychoanalytic 
theory emphasize the importance of interperson£d loss in depression, 
psychoanalytic theory focuses only on the loss of "narcissistic supphes" 
(Kapl£m,1991, p. 217) and the Impact of this loss on self-esteem. In 
addition to this loss of gratification, self-in-relatlon theory proposes that 
another, and perhaps more Important, effect of interpersonal loss is on 
"the chance to take part hi a mutually affirming relationship" (p. 217). 
This type of loss affects a woman's sense of her own worth by cedling into 
question her relational abilities, abilities that are hittmately tied to her 
sense of self, according to Kaplan. To women, relationship loss may be 
felt primarily as a "failure of the selT (218). 

Another feminist theorist, Kaschak (1992) reiterated the view held 
by many feminist theorists that the most common psychologiceQ 
disorders found in women, such as depression, anxiety disorders, and 
dissociative disorders can be best understood by reference to the 
normative demands of the female role. For example, in the case of 
women's depression, Kaschak cited a Unk between women's "overriding 
emphasis on relational aspects of life" and thefr vulnerability to 
depression following loss (1992, p. 181). She further contended that 
because of the common developmental experiences of women In American 
culture, a sense of Impending or actual loss becomes embedded in thefr 



30 

expectations and functioning. Expanding the scope of her thinking on 

loss beyond the usual focus on relationship loss, Kaschak's work 
parallels aspects of Jack's (1991) conceptualization of loss of self. She 
has identified loss of self-control, loss of self-definition, loss of a sense 
of meaningfulness, and loss of the possible, as common to women's 
experience and as potentially debilitating. 

In support of her position on the Importance of loss to women's 
depression, Kaschak (1991) referred to the literature on sex differences, 
marriage and depression. This literature shows consistently that married 
women are more likely th£in married men to be depressed, and that 
married women who do not work outside of the home show the highest 
incidence of depression. Cox and Radloff (1984) reported similar findings 
stating that marriage and motherhood tend to increase women's risk of 
some psychiatric disorders, while decreasing rates of these same 
disorders in men. In her smalysis of these findings, Kaschak focused on 
women's tendency to place the needs of vedued others first and points 
out the potential costs of long-term self-denied — the loss of identity or 
the capacity for self- definition. 

In their discussion of sex differences in unipolar depression, 
Hamilton and Jensvold (1992) posed the question of whether there is a 
depressogenic aspect to the female personaUty. They offered four possible 
conceptualizations of the link between personality and depression. First, 
they suggested that personality type may increase or decrease 
susceptibility to depression. However, they pointed out that studies 
attempting to show a connection between certain gender -linked 
characteristics, such as dependency and assertlveness, cind depression 
have failed to do so. The second conceptualization suggested that some 



31 

types of depression may actually alter personality or one's ability to 

assess it. In the few studies exploring this idea, there is little evidence for 
the existence of a gender or sex difference. A third conceptualization 
states that certain personality types and depressive s5mdromes may "co- 
occur" in relation to a third variable. In understeinding women's high 
rate of depression for instance, the covariate might be a histoiy of 
victimization or some unidentified biological factor. The final 
conceptualization looks at the possibility that the depressogenic 
personality may actually constitute an as-yet unidentified form of milder 
depression. Hamilton and Jensvold agreed that fiirther research is 
needed in this area to sort out the tangle of personality types and types 
of depression. In fact, the diagnosis of depressive personality was 
considered and rejected for inclusion in the latest edition of the 
Diagnostic and Statistical Manual of Mental Disorders (APA, 1994). 

Jack's Theory of Depression in Women 

In her recent research efforts, Jack {1991; Jack & Dilll992) has 
undertaken the substantisd project of challenging existing theories of 
women's depression. She joins the growing body of feminists who believe 
that the field's understanding of women has been seriously limited by the 
use of primarily male models of health and development, models which 
have tended to ignore either sex and gender differences or to view female 
patterns as deviant. Jack's work is an attempt to re-examine the high 
incidence of depression in women fi-om a less biased perspective than 
that of traditional psychoanalytic theory and to build on the concept of 
the relational self as a means to better understanding of women's 



32 
strengths and vulnerabilities. 

In order to understand clearly women's depression, Jack (1991) 
took as her starting point the need to listen to the voices of women as 
they described their internal worlds. To this end she designed a 
longitudinal study that involved interviewing 12 women diagnosed with 
either dysthjnnia or major depression. These women participated in 
lengthy, semistructured interviews shortly after being diagnosed as 
depressed, and again approximately two years later, to assess for changes 
in Eiffective, cognitive, and social functioning. Rather than focusing on 
extemsd factors known to be associated with women's depression—such 
as domestic violence and economic oppression— Jack's interview 
questions were aimed at bringing to light women's lived experience. She 
w£uited to hear directly from the participsuits about their lives, their 
losses and their sadness (1991, p. 2). 

Based on the results of the interview study. Jack developed a scale, 
the Silencing the Self Scale, designed to measure "gender -specific 
schemas h57pothesized to be associated with depression in women" (Jack 
& Dilll992, p. 97). In her discussion of the process of "silencing the self," 
she builds on the idea of a relationeil self as the normative femede self 
and looks spectflcaUy at how women "create and maintain safe intimate 
relationships" (1992, p. 98). Her basic premise is that the maintenance of 
high quahty relationships is so central to a woman's identity and overall 
self-ev£duation, and that she may at times, both literally and 
metaphoricEilly silence herself in her efforts to maintain the valued 
connection. It is this self-silencing that Jack sees as so damaging to 
women. Over time, the process of shutting down or splitting off parts of 
the self, in order to better conform to the female role imperative, leads to 



33 
a decrease in self-esteem and possibly to feelings of loss of self and 

ultimately depression. 

Jack's theory, however, unlike theories that have tended to 

denigrate women for their dependence on relationships, affirms the need 

for healthy attachments as natural throughout the lifespan. She states 

that from the perspective of the relational self, depression does not Eirise 

from an inability to detach from an intimate relationship, but from "the 

Inability to make or sustain supportive, authentic connection with a 

loved person" (1991, p. 16). Instead of the traditional focus on 

developmental deficits as the source of dependency and the cause of 

depression following relationship loss. Jack has recommended looking at 

the forms of connection that tend to result in loss of self as a more 

useful approach to understanding women's depression. "Women's 

vulnerability to depression does not lie in their 'dependence' on 

relationships or in thefr depressive response to loss, but in what happens 

to them within thefr relationships" (1991, p. 21). The sex difference in 

depression between married women and married men becomes potentially 

more explainable in this newer framework. 

Jack is c£ireful edways to look at women in light of gender norms 

and sexual inequality. In contrast to theories that focus exclusively on 

personality, Jack has looked at the interaction of culture and personality 

and thefr combined impact on women's sense of self and behavior. She 

has pointed out that ultimately, "self-evaluation holds the key to 

understanding gender dlfierences in the prevalence and dynamics of 

depression (1991, p. 90) and that women's sense of "goodness" is based 

in thefr abUity to make and maintain authentic, lasting attachments. In 

carrying out the adult tasks of establishing a strong sense of identity and 



34 
securing healthy attachments, some women change or sacrifice the self 

in order to sustain connections to others. It Is this loss of authentic 

voice that seems to play a significant role in explaining the high 

incidence of depression in women. 

Hypotheses 

This study attempts to advance the field's understanding of 
women's depression by compeuing predictions based on competing 
theoretical models discussed previously. Three sets of hj^potheses 
correspond to three competing sets of predictions regarding the 
relationship between loss of a romantic partner, self loss, and level of 
depression. (See Figure 1 for a visual depiction of these). 

The first hypothesis, the Traditional Model hypothesis, predicts 
only a main effect of relationship loss on depression. This model does 
not predict either a self loss main effect, nor an interaction between 
relationship loss and self loss. The expected direction of the relationship 
loss main effect is that depression should be significantly higher if a 
recent relationship loss has occurred, than if such a loss has not 
recently occurred. 

The second hypothesis, the Jack Model hypothesis, predicts only a 
main effect of self loss on depression. This model does not predict either 
a main effect of relationship loss, nor an interaction between 
relationship loss and self loss. The expected direction of the self loss 
main effect is that more significant levels of depression should be 
associated with greater degrees of self loss. 

The third hypothesis, the Potentiation Model hypothesis, differs 
from the Traditional and Jack models in that it predicts an Interaction 



35 
between relationship loss Eind self loss on depression. This model makes ? 

no predictions about msiin effects because, according to this perspective, ( 

j 
the presence or absence of one or both main effects is less crucial i 

conceptucilly than the expected influence of relationship loss to j 

potentiate self loss and vice versa. [ 

Sex of participant has been included to £issess the external validity of l 

the findings. The logical prediction is that the results will be similar in 

form for men and women, however, the overall fi-equency of depression in 

men may be lower, consistent with past research. 



Fi gure 1 
Predicted Level of Depression. According to the Three Models 



36 



Panel A: The Traditional Model 



Relationship Loss 
Present Absent 



Present 



Loss of Self 



Absent 



High 


Low 


Hi^ 


Low 



Panel B: Jack's (1991) Model 



Relationship Loss 
Present Absent 



Present 



Loss of Self 



Absent 



Hi^ 


Hi^ 


Low 


Low 



Panel C: The Potentiation Model 



Relationship Loss 
Present Absent 



Present 
Loss of Self 

Absent 



Highest 


Moderate 


Moderate 


Lowest 



CHAPTERS 
METHODOLOGY 



The prlmaiy objective of this study is to investigate the role of 
relationship loss, self loss, and the potentiating effects of combining 
these two types of loss on the level of depressive affect in women £ind 
men.The current study will incorporate the current theorizing on 
women's relational development as a potential means for better 
understanding women's greater susceptibility to depression. In a 
departure from the more traditional models, which link women's 
depression primarily to the loss of a significant other, the emerging 
models focus much more on the woman's sense of identity — or loss of 
this sense of identity— In the context of intimate relationships. 
Differences in the early gender identification process and the gender role 
socicdization process are believed to contribute to the likelihood that a 
woman will experience "feelings of guilt, shame, and depression with the 
failure of intimate ties" (Jack, 1991, p. 13). 

Participants 

Participants in this study were 257 undergraduates at the 
University of Florida, during the spring and summer semesters of 1994. 
Students were enrolled in one of two psychology courses: Personal 
Growth or Psychology of Personality. At a later date, an additional data 
set was collected and will be separately analyzed. The second data set 
Included 172 participants. These participants were edso University of 
Florida students in a Personal Growth class. 

37 



38 

Procedures 

Data were collected during one portion of a regular class meeting. 
The purpose of the study was briefly explained, as were the means for 
protecting the anonjnnity and confldenti£ility of all results. The need for 
thinking through answers, and the importance of completely and 
honestly answering all questions was stressed. Questionnaire packets 
were distributed. Including the Beck Depression Inventory (BDI), the 
"Silencing the Self Scale (STSS), the Depressive Experiences 
Questionnaire (DEQ), and a number of questions concerning 
relationship loss generated spectflcally for this study. Basic demographic 
data were also collected.The average time to complete the packet was 
approximately 30 minutes. 

Independent Variables 

Silencing the Self Scale 

One of the primsiiy Independent measures of the study was 
designed to assess the "loss of selT which can occur in the context of an 
intimate relationship. Jack designed the "Silencing the the Self Scale" 
(STSS) to "investigate gender -specific schemas hypothesized to be 
associated with depression In women." The scale is derived from her 
previous qualitative work, which involved Interviewing women diagnosed 
with major depression. Items for the scale came fi-om the women's own 
perceptions of their problems and feelings, and are aimed at exploring 
"the self-negating process that some women experience in their efforts to 
maintain intimate connection" (Jack & Dill, 1992). Jack's intent was to 



39 

expose the means by which learned gender role behavior shapes a 

woman's interpersonal Interactions and her beliefs about her own worth. 
The emphasis is on cognitive schemas, not on personality. 

The STSS consists of thirty-one statements paired with a Likert- 
type scale, which consists of five choices ranging from strongly disagree 
on one end to strongly agree on the other. In addition, the final item has 
an addendum Eisking participants who scored four or five, on that 
particular item, to respond in more detail to the question. This more firee 
form question was not included in the current study, due to potentied 
problems in data processing. Four "rationally" derived subscales reflect 
critical components of Jack's proposed theory of women's depression 
(Jack, 1991; Jack & Dill, 1992). Each of the subscales was designed to 
illustrate a related, but distinct aspect of "loss of selT. The first 
subscale, called "externalized self-perception" is made up of items which 
indicate a tendency for a woman to judge herself by external standards. 
Item 6 serves as a representative example, "I tend to Judge myself by how 
I think others see me." The second subscale, labeled "care as self- 
sacrifice," includes items targeting a specific pattern by which a woman 
may put the needs of others first, without adequate consideration of her 
own wishes or needs. For instance, "Caring means choosing to do what 
the other person wants, even when I want to do something different." 
Third, comes the " Silencing the Self Scale," these items focus on the 
inhibition self-expression and of actions which might lead to conflict 
and potentiaUy contribute to relationship loss. An example fi-om this 
scale is item .14, "Instead of risking confirontations in close relationships, 
I would rather not rock the boat." FinaUy, the fourth subscale caUed "the 
divided self contains items designed to capture some women's experience 



40 
of outer compliance to female role imperatives, while the inner self 

becomes progressively more angry and hostile. Item 16 is a representative 

example, "Often I look happy enough on the outside, but inwardly I feel 

angry and rebellious." 

Higher scores on the STSS reflect the degree to which a woman 
feels the need to conform to the demands of the female gender role, not 
just the degree of depression. Scores on the scale can range from 31-155. 
As already mentioned, scores at the upper end would indicate that a 
woman Is struggling with strong intemgil demands to fulfill perceived 
gender role expectations, while lower scores would Indicate a woman who 
feels significantly less constrained by these role imperatives. 

The scale was chosen for this study because of its potential for 
expanding our understanding of a significant mental health problem. As 
an initial step in her research Into women's depression. Jack (1991) did a 
longitudinal study of twelve women with diagnoses of dysthymia or of 
major depression. Her extensive interviewing of these women led to the 
genesis of the first draft of the scEile, which was then reviewed by a group 
of psychologists for face validity. Items were also reviewed by female 
undergraduates to check for "comprehensibility Eind clarity." Next, using 
three diverse samples of women, Jack and Dill (1992) estabUshed 
baseline measures of reliability and validity. Volunteer participants were 
drawn from a large state university (n=63), fi-om three battered women's 
shelter (n=141), and fi-om a group of new mothers who had reported 
alcohol, marijuana, tobacco, or cocaine usage during their pregnancies 
(n=270). The samples were composed predominantly of Caucasian women 
in their late adolescence through their thirties. The majority of women 
were fi^om middle and lower socioeconomic levels, and reported a variety 



41 
of current relationship statuses, including single, married, pEirtnered and 

divorced 

Separate measures of the scale's internal consistency were done 

for the three different sample groups with cdpha coefiBcients ranging from 

.86 to .94. The four subscales were edso assessed for internal consistency. 

All subscales except "care as self-sacrifice" demonstrated acceptable 

intemEil consistency with results ranging from .74 through .90. At this 

phase of instrument development, Jack and Dill (1992) recommend 

against separate use of the "care as seK-sacriflce" subscede because it 

showed showed relatively weak Intemgil consistency. The STSS showed 

strong test-retest reliability with scores ranging from .88-. 93, b£ised on 

Spearman-Brown coefflcients. 

Jack and Dill (1992) investigated the construct validity of the STSS 
in several ways. Results of the STSS and BDI were found to have the 
expected positive correlation, approximately r=.50 within each subgroup 
of the sample, showing that STSS scores were related to level of 
depression as measured by a well established self-report instrument for 
depression. The samples were anatyzed indejjendently based on the 
researchers' contention that members of each sample group would be 
dCEdlng with specific pressures based on the role demands of thefr unique 
sociEd context. This hypothesis was also supported. Analysis of variance 
indicated significant differences between the means of the three samples, 
with the college students scoring lowest on both the STSS and the BDI, 
the sample of new mothers scoring In the intermediate range, and the 
battered women scoring highest. 

Although additional studies are clearly required to more fully 
document the reliability and validity of the STSS, the results just 



42 
outlined provide a clear indication of the STSS's validity and reliability. 

Theoreticalfy, the STSS offers an expanded understanding of women's 
depression. Its focus on, the impact of "loss of selT in a relationship, 
provides the means for investigating one of the central questions of the 
current study. The major weakness of the STSS, in terms of the current 
study. Is the complete absence of data on men. Because fundamental 
assumptions are being made concerning gender differences, men's 
responses are needed to more thoroughly test Jack's theory and 
Instrument. 
Sex 

The second independent variable in the present study will be the 
biological sex of participants, female or male. As mentioned above, both 
Jack's theoretical work and her research have focused exclusively on 
women. One goal of this study is to test whether relationship loss has a 
similar effect on members of both sexes, or whether differences actually 
exist. 

Relationship Loss Questionnaire 

The third independent variable concerns the presence or absence 
of a relationship loss over the previous twelve months. Since a survey of 
the current literature failed to locate a suitable instrument, a brief 
questionnaire was designed to succinctiy coUect the needed information. 
Ten questions cover the presence or absence of a romantic loss, the 
timing of the loss, which partner was the instigator of the breakup, the 
importance of the relationship, overall satisfaction with the relationship, 
and the assignment of responsibility for the failure of the relationship. 
Also included, is a direct question about "giving up the selT as a way of 
maintainhig the former relationship. Though they have less direct 



43 
relevance for the present study, three items ask about current 

involvement in a relationship. It is anticipated that the quality of a new 

relationship may mitigate the impact of the previous loss, and/or 

perceptions of the past relationship. 

Dependent Variables 

Beck Depression Inventorv 

A central aspect of the present study involves the measurement of 
level of depression following the breakup of an intimate relationship. The 
dependent measure chosen for this purpose was the Beck Depression 
Inventory. According to Shaver and Brennan (1991), the Beck Depression 
Inventory is "the most prominent and frequently cited self-report 
measure of depression." Consisting of 21 items, the Beck Depression 
Inventory (Beck, 1967) (see Appendix C ) may be used either for 
measuring the intensity of depressive s5miptomology, or as a brief 
screening measure. Both of these uses have relevance for the present 
research. Beck chose his items to represent 21 distinct "symptom- 
attitude" categories falling under the four more general headings of 
behavioral, affective, cognitive, and physiological manifestations of the 
disorder. Each item consists of four statements scored from 0-3 which 
the participant is asked to choose among. Statements scored "0" 
represent the nondepressed end of the continuum with increasing scores 
indicating a greater degree of depression. For example, item A focuses on 
sadness. It consists of the following four statements: "I do not feel sad" 
(scored 0), "I feel sad" (scored 1), "I am sad all the time and can't snap 
out of it" (scored 2), and "I am so sad or unhappy that I can't stand it" 
(scored 3). Total scale scores on the BDI can range from to 63, with 



44 
various interim ranges representing different degrees of depression. 

Following the most widely used criteria, scores from to 4 suggest little 
or no depression, mild depression is suggested by scores from 5 through 
13. moderate depression between 14 and 20, and severe depression by 
scores 21 and above. 

One of the main strengths of the BDI is its proven rehabillty and 
validity. According to Shaver and Brennan (1991), the BDI has been 
shown to have a split-half reliability coefiBcient of .86, and test-retest 
reliability with coefBclents the in the .70's when repeated testing is done 
over a span of several weeks. In terms of validity, the BDI is weU known 
for its construct validity and, in fact, is often used to evaluate new 
instruments. During the past approximately twenty-five years, the BDI 
has repeatedly been shown to be positively correlated with both clinically 
derived, psychosocial, and physiological measures of depression, 
demonstrating ample evidence of convergent validit5^ Though depression 
is often difficult to discriminate from anxiety, the BDI has been used 
somewhat successfully for this purpose, and also for distinguishing 
depression from other psychiatric diagnoses. In other words, reasonable 
discriminant validity been has shown. 

With reference to the current study, the BDI has several strengths 
and weaknesses. Its major weakness is that it was designed for use with 
clinical populations, not with the normal population which is targeted 
by the study. However, the test has been used with adults of all ages and 
many cultural and ethnic groups, and will serve very adequately for 
present purposes. The major strengths of the BDI are its proven "track 
record", and the option to derive scores which tadlcate not Just the 



45 
presence of depression, but the level or degree of severity of depression, if 

depression is present at all. 
Depressive Experiences Questionnaire . 

The second measure of depression was chosen to test the more 
traditional model, in which women's depression is seen as arising from 
unmet dependency needs following the loss of a significant other. The 
Depressive Experiences Questionnaire was developed by Blatt, D'AfQitti, 
and Quinlan in 1976. It was designed to tap two primary dimensions of 
depression, anacUtic and introjective, which Blatt had identified in his 
earlier work and which reflect his psychoanal5^c understanding of the 
causes of depression (1974). Anaclltic depression is characterized by a 
longtag to be cared for by another and by feelings dependency, fear of 
abandonment, and helplessness. In contrast, introjective depression is 
characterized by feelings of "not measuring up", of the self as a failure, 
including accompanying guilt and self-denigration (Shaver and Brennan, 
1991). Both tyi>es of depression are seen as reflecting personality styles 
and can be applied to the continuum of depression from normal mood 
fluctuations to the ftill clinical disorder (Welkowitz, Lish, and Bond, 
1985). 

The DEQ consisted originaUy of 66 items, but involved a complex 
scoring system which Welkowitz et al (1985) revised. The modified DEQ 
consists of 45 items and now allows for clearer comparisons between 
genders. Since gender difiierences are central to the questions raised by 
the current study, the updated scale and scoring system will be used. 
Under this system, participants attain a certain score for each of three 
subscales: dependency (equivalent to the anaclltic dimension), self- 
criticism (equivalent to the introjective dimension), and efiicacy. Final 



46 
scale scores are based on the mean of scores for items loading on each of 

the specified subscales. 

During their preliminary work revising the DEQ, Welkowitz and 
her colleagues (1985), found internal consistency scores, based on 
Cronbach's alpha, as follows: dependency .81, self-criticism .86, and 
efficacy .72. Though no test-retest reliability data was cited, previous 
work with the original form of the DEQ "indicated considerable stability- 
over time (Shaver and Brennan,1985). 

Evidence for convergent validity has been shown for both versions 
of the DEQ, each of which showed predictable correlations with other 
established measures of depression and self-concept. Klein (1989) also 
correlated scores derived from the alternative scoring systems and found 
them to produce very similar results. 

The strengths of this scale for the purposes of the present study 
include its applicability to a nonclinical population of participants, and 
the theoretical foundations of the scale which posit the existence of 
several types of depression and link these types to personality styles, or 
possibly, gender or gender role pressures (Blatt, D'Afflitti, & Quinlan. 
1976; Welkowitz et al, 1985). According to Shaver and Brennan, the main 
weakness of the revised scale is the intercorrelation of the dependency 
and self-criticism subscales, which may indicate that the scales do not 
actually represent totally distinct factors. However, for present purposes, 
the level of intercorrelation, at .60 is acceptable. 

Data Analysis 

All three hypotheses were evaluated with two hierarchical multiple 
regressions, one for each measure of depression (dependent measures). 



47 
The predictive (or Independent) variables were sex, relationship loss, and 

self loss as well as all of their two and three way interactions. Sex wlU be 

entered first, then the other two main effects, then the two-way 

interactions, and finally the three-way interactions. 



CHAPTER 4 
RESULTS 



In order to compare the three models linking types of loss to 
depression, two multiple regression analyses were performed. Using a 
sample of 257 undergraduates, the impact of loss of a pcirtner, self loss 
(the Jack Model), or the combination of both of these losses was 
assessed. The first multiple regression involved the use of the BDI as the 
criterion variable, the second used the dependency subscale of the DEQ. 
Independent variables included the presence or absence of a recent 
relationship loss, scores on the STSS as Indicators of degree of self loss, 
and sex of the participants. The various interaction terms: breakup by 
STSS score, breakup by sex, STSS scores by sex, and finally, breakup by 
STSS scores by sex were also included as predictor variables. In each 
multiple regression, the Type III sums of squares were used to calculate F 
values. 

Sample Characteristics 

Of those participants reporting demographic information, 171 or 
66.5% were female and 86 or 33.5% were male. Ages of participants 
ranged from 17 to 40, with a mean age of 21.5 years. The participgrnts 
were predominantly Anglo-American or Euro- American, 77.6%, with the 
remaining participants being Afiro-American, 4.9%, Hispanic American, 
6.1%, Asian American, 7.3%, Native American (American Indian), 0%, or 
Other, 4.1%. Only 0.8% of participants were first year students (n = 2) , 
7.4% were sophomores (n = 19) , 35.8% were Juniors (n = 92) , 53.3% 



48 



49 
were seniors (n =137), and 2.7% were post- baccalaureate or graduate 

students (n=7). Approximately 53.2 % of participants reported currently 

being married or partnered (cohabiting or not), 46.7% reported that they 

were currently single, separated, divorced, or widowed. Ninety-stx and 

one-half percent of the participants described themselves as 

heterosexual, 0.8% described themselves as homosexual, and 2.7% 

bisexual. 

Means and Frequencies 

The means, standard deviations, minimum and maximum values 
of participants' responses to key questionnaire items are depicted in 
Table 1. In addition, two other questionnaire items, which are frequency 
items, are relevant. First, of the 254 participants who chose to answer 
the question asking whether they had experienced the breakup of an 
intimate relationship in the past 12 months, 104 or 59% indicated "yes", 
and 150 or 41% indicated "no." 

This item was of special Importance given the study's focus on the 
possible link between relationship loss and depression. In the end, the 
most critical analyses could include only those participants who had 
experienced a recent loss. Second, in response to the question asking 
participants If they are currently involved in an intimate relationship, 
159 or 62% indicated "yes" and 89 or 38% indicated "no". This item was 
considered to be important for its potentially mitigating effect on 
depressive S3miptoms precipitated by peist losses. 



50 



Table 1 

Means. Standard Deviations. Minimum and Maximum Values on 
Responses to Key Questionnaire Items 



Variable N 

JACK 257 

GAVESELF 254 
BECK 257 

BLATT 257 

WHEN 254 

CHOICE 254 
OLDIMP 253 
RESPONSI 254 
OLDSAT 254 
CURRIMP 254 
CURRSAT 254 

Note. Jack = scores on the Silencing the Self ScEile; Gaveself = scores on 
question 78 of the Relationship Loss Questionnaire (RLQ), range 0-8; 
Beck = scores on the Beck Depression Inventory; Blatt = scores on the 
Dependency Scale of the Depressive Experiences Questionnaire; When = 
scores on question 75 of the RLQ, range 0-6; Choice = scores 76 of the 
RLQ, TEinge 0-9; Oldlmp = scores on question 77 of RLQ, range 0-9; 
Responsi = scores on question 79 of the RLQ, range 0-9; Oldsat = 
scores on question 80 of the RLQ, range 0-9; Currimp = scores on 
question 82 of the RLQ, range 0-9; Currsat = scores on question 83 of 
the RLQ, range - 9. 





Minimum 


Maximum 


Mean 


Std Dev 


1.1 


4.7 


2.47 


0.66 


0.0 


8.0 


2.13 


2.69 


0.0 


43.0 


6.96 


6.45 


1.2 


6.2 


3.70 


0.93 


0.0 


6.0 


1.43 


2.04 


0.0 


9.0 


2.01 


3.02 


0.0 


9.0 


3.04 


3.65 


0.0 


9.0 


2.40 


3.10 


0.0 


9.0 


2.17 


2.81 


0.0 


9.0 


4.93 


3.98 


0.0 


9.0 


4.34 


3.69 



51 
Hypothesis Tests 

The h3rpotheses were analyzed in two multiple regression analyses, 
one each for the BDI and the DEQ, which served as the dependent or 
criterion variables. The independent or predictor vEiriables were 
relationship breakup, scores on the STSS, sex, and their Interaction 
terms. The Type in sums of squares were used to calculate F values. 

The first hypothesis was the Traditional Model hypothesis, which 
posited that there should be a main efiiect for relationship loss on the 
two mcEisures of depression, and no main effect for self loss, nor a 
relationship loss by self loss interaction. This hypothesis was not 
supported. There was no significant main efiect for relationship loss 
either for the BDI, F (1,246) = 1.89, g < .18, or for the or the Dependency 
Subscale of the DEQ, F LI ,246) = 0.86, p < .36. 

The second hypothesis was the Jack Model hypothesis which 
posited that there should be a main effect for self loss on the two 
measures of depression, and no main efiect for relationship loss, nor a 
relationship loss by self loss interaction. This hypothesis was clearly 
supported. First, there was a significant main efiiect for self loss for the 
BDI, F(l,246) = 25.78,^ < .0001, with increased self loss associated with 
greater depression. Likewise, there was a significant main effect for self 
loss for the Dependency Subscale of the DEQ, F( 1,246) = 45.50, p < 
.0001. Agcdn self loss was associated with greater depression. 

The third hypothesis was the Potentiation Model hypothesis, which 
posited that there should be an interaction effect for the interaction of 
relationship loss and self loss on the two meeisures of depression. The 
model made no predictions regarding m£iin effects for relationship loss or 



52 
selfless. This hypothesis was not supported. There was no significant 

interaction effect either for the BDI, F(l,246) = 1.60, p < -21, or for the 

Dependency Subscale of the DEQ, F( 1,246) =1.48, p < .23. 

Finally there was little evidence that the general support for the 

Jack Model was moderated by sex differences. Only one main or 

interaction effect term, in either multiple regression, even approached 

statistical significance. The one interaction effect that approached 

significance was for the interaction of relationship loss, self loss and sex 

on the Dependency Subscale of the DEQ, F(l,246) = 3.52, p < .07. 

Replication of Hypothesis Tests 

As mentioned in the method section, a second data set was 
collected late in the summer term. At that time an additional 172 
University of Florida undergraduates completed the "Life Assessment 
Questionnaire". Results of this replication using identical multiple 
regression Einalyses follow. 

Hypothesis 1 or the Traditional Model hypothesis which predicted 
only a main effect for relationship loss for the two dependent measures 
was not supported, BDI, F(1.148) = 0.00, p < .96; Dependency Scale of 
the DEQ, F( 1,148) = 0.11, p < .75. Hypothesis 2 or the Jack Model 
hypothesis, which predicted a main effect only for self loss was once 
again clearly supported, BDI, F( 1,148) = 4.80, p < .04 ; Dependency Scale 
of the DEQ, F(l, 148) = 9.25, p < .003. And finally, the sole prediction 
for hypothesis 3, or the Potentiation Model hypothesis, was an 
interaction effect for relationship loss and self loss. No significant 



53 
interaction effect was found, BDI, F(l,148) = 0.12, p < .73; Dependency 

Scale of the DEQ, F( 1,148) = 0.01, p < .94. 

As with the Jack Model results from the original data set, there 
was no compelling support for sex differences in terms of either main 
effects or interaction effects. This was the case for both the BDI and the 
DEQ. 

On the whole, the results of the two separate analyses were 
remarkably similar, showing strong suppxirt for a link between the 
presence or degree of self loss and the intensity of depression following a 
relationship loss. Though fewer men than women reported self loss, when 
self loss did occur in men, the same pattern of connection between self 
loss and depressive symptoms was demonstrated; a pattern which had 
previously been assumed to be applicable only to women. 

AnciUarv Analyses 

In addition to the results previously described, correlation 
coefiBcients were calculated for each pair of continuous data variables 
from the original data set only. These correlations are depicted in Table 
2. Some of the more notable aspects of this table are discussed below. 

In order to address the possibility that absence of support for the 
traditional model hypothesis might be explained by the insensitivlty of 
the indicator of loss (see Question 74, see Appendix F), the correlations 
between the item asking how long ago the breakup occurred and scores 
on the BDI and the Dependency Subscale of the DEQ were Inspected. 
These correlations, as can be seen from Table 1, were small and not 



54 
statisticaUy significant, suggesting that recent breakups were not more 

associated with depression than the ones that occurred longer ago. 

Likewise, one could argue that who initiated the breakup would 

importantly influence the degree of depressed response, so the correlation 

between the item asking about who chose the breakup (see Question 76, 

Appendix F) and scores on the BDI and the Dependency Scale of the 

DEQ were looked at. Again these correlations were close to and not 

statistically significant, suggesting that this aspect of breakup was not 

more indicative of depression than the original measure. 

As with the previously discussed correlations, the correlation 

between the measure of the importance of the recently terminated 

relationship (see Question 77, Appendix F) and the BDI and DEQ scores 

were close to and nonsignificant. Two other measures associated with 

relationship loss were also inspected, one involving which partner was 

attributed responsibility for the breakup (see Question 79. Appendix F) 

and, the other how satisfied the cUent was the past relationship. Again, 

these correlations were near and nonsignificant. None of these results 

suggest support for the Traditional Model hypothesis. 

Taken together this pattern of correlations underscores that when 

viewed fi-om the perspectives of more precisely when the breakup 

occurred, who chose it, how important it was, who was responsible for 

the breakup or how satisfying the relationship was, the pattern was the 

same as on the original measure. That is, no support was found for the 

Traditional Model hypothesis on any of these widely varying measures of 

the parameters of relationship breakup. Parenthetically, all five of these 

auxiliary measures associated with breakup, correlated significantly with 

one another at moderate to high levels of magnitude (See Table 2). 



55 
Inspection of the correlation between scores on the BDI and the 

Dependency Scale of the DEQ reveals only a small to moderate 
relationship between the two measures. This underscores the importance 
of selecting more than one measure of depression, as well as the potency 
of self loss in accounting for significant variance in each of these 
measures. 

Although self loss, not relationship loss, clearly accounted for the 
significant varisince in predicting depression scores, there is an 
interesting set of associations between relationship loss and one aspect 
of self loss. Even though scores on the STSS did not correlate 
significantly with any of the measures of relationship loss, another 
question that directly asked participants whether they had given 
themselves up in the context of the failed relationship (see Question 78, 
Appendix F), correlated significantly, positively, and at moderately large 
magnitudes with each of the breakup associated measures (namely, when 
the breakup occurred, who chose it, whether it was important,who was 
responsible for the breakup or how satisfying the relationship was). This 
pattern of associations is obviously complex and not amenable to quick 
interpretations, but may ultimately suggest directions for further 
exploring the conceptualization of self loss. 



56 



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CHAPTERS 
DISCUSSION 

What Nora told Kikl about her romantic past is that she began to 
see that in each instance, as she molded herself more to her loved 
one's life, he turned just a little bit colder, as she, Nora 
disappeared piece by piece. (Otto, 1994, p. 83) 



All companionship c£in consist only in the strengthening of two 
neighboring solitudes, whereas everything that one is wont to call 
giving oneself is by nature harmful to companionship: for when a 
person abandons himself, he is no longer anything, and when two 
people both give themselves up in order to come close to each 
other, there is no longer any ground beneath them and their being 
together is a continual falling. (Rilke,1975, p. 27-28) 



The purpose of this study has been to explore the roles of 
relationship loss and self loss as possible triggers of depression in college 
women and men. This chapter will focus on discussion of the tests of the 
three principal hypotheses and on other analyses of interest. Also 
included will be a brief discussion of the strengths and limitations of the 
study, and the implications for both future research and for 
psychotherapy. 

Hvpothesis 1 

Hypothesis 1 tested the Traditional Model, which predicted a main 
effect of relationship loss on level of depression. This model of depression 
was not supported by patterns of scores on either of the two depression 
measures, the Beck Depression Inventory or the Dependency Scale of the 
Depressive Experiences QuestionnEiire. 



57 



58 



The lack of support for the Traditional Model of Depression in this 
study lends additional credence to the caUs of feminist theorists in the 
fields of psychology and psychotherapy to re-examine the core theories 
that purport to explain the development or causes of psychopathology in 
women. In particular, the Dependency Scale of the DEQ was designed to 
target a specific type of depression, which is defined by feelings of 
abandonment, dependency, neediness, and helplessness. Scores on this 
scale showed no significant link between the loss of a romantic 
relationship over the past year and the level of anaclitic depression. This 
finding poses a chaUenge to long-accepted clinical wisdom, which has 
presumed that a connection exists between the onset and severity of 
depressive symptomology in women and the recent loss of 
a significant other who was presumably providing for important 
emotional needs. Although the findings of this study are only one piece 
of a complex puzzle, the clear lack of support for Hypothesis 1, the 
Traditional Model, compels further exploration of alternative causative 
and correlative factors in women's depression. Furthermore, this lack of 
support for the Traditional Model hypothesis demonstrates the need for a 
continuing dialogue between research and clinical practice, including a 
strong argument for the use of well-designed studies that test widely 
accepted clinical lore. 

Hypothesis 2 

Hypothesis 2, the Jack Model hypothesis, predicted a significant 
relationship between self loss and level of depression as measured by the 
BDl and the DEQ Dependency Scale. Using the STSS as the independent 



59 



measure, a relationship between the degree of self loss and level of 
depression was clearly demonstrated on both dependent measures. In 
short, the participants who reported a greater tendency to have lost a 
sense of self showed higher levels of depression on two depression 
instruments. The Jack Model predicted no interaction between self loss 
and relationship loss Euid none was found. 

The clear support (p < .0001 in the initial analyses) for this newer 
model of women's depression is an intriguing outcome. It points to the 
possibility that, whereas loss is in feict a major factor in the etiology of 
depression, researchers and clinicians may have been concentrating on 
the wrong type of loss. During the initial, qualitative phase of her 
research. Jack's goal was to let go of preconceptions about the causes of 
depression in women. Out of the interview data she collected and 
carefully scrutinized. Jack developed the concept of loss of self, which 
results from the current study have further validated. 

HvDothesis 3 

Hypothesis 3, the Potentiation Model, predicted that the 
expertence of both self loss and the loss of a significant other would 
interact in their contribution to the development of depression. This 
model anticipated not just an additive effect of self loss and other loss, 
but a synergistic or potentiating effect, which would have been 
manifested in the current study by significantly higher depression scores 
for those participants reporting both types of loss than for any of the 
other groups. However, hypothesis three was not supported. 



60 

The results In this study were extremely clear: the loss of a 
significant other, through a relationship breakup, did not predict 
depressive symptomology; nor did the interaction of relationship loss and 
self loss. Given this finding, it is not surprising that the Potentiation 
Model was not supported. Instead, the data clearly pwint to the newer 
concept of self loss as a potent predictor of depression. 

Sex Differences 

The sex of study participants was included in order to look for 
patterns of difference or similarity between women £ind men. It was 
predicted that general scoring patterns would be similar for both sexes, 
but that the overall fi-equency of depression among women would be 
higher. This, two-part prediction was supported and expands to an even 
greater extent the relevance of the Jack Model for understanding, 
evaluating and treating depression. 

In short, because Jack's theory was thought to apply to women 
only, the results of the current study may lead to expansion of her 
thinking. For example, rather than assuming that the most likely source 
of male depression is task failure, it might be useful to explore the 
possibility that "loss of self a similarly powerful contributor to male 
depression. Also, given these results it will be Important to look more 
thoroughly at the connection between the tendency to give up one's self 
and the possible sources of this tendency in female upbringing or gender 
roles. Whereas loss of self was more common in women, as was 
depression in general, some male participants did indeed show self loss 
£is well as the depression that is associated with it. 



61 
Limitations 

The sample employed in this study consisted of male and femEile 
students enrolled in undergraduate psychology courses at the University 
of Florida. The average age of subjects was approximately 22 years old, 
and most subjects fell mto the 19-25 year age range. Although there was 
some ethnic diversity among the participants, overall numbers were not 
sufficient to perform separate Emafyses baised upon ethnicity. Data on 
socioeconomic status were not collected, however, college students from 
this university typically come from middle class backgrounds. Very few 
participEints described themselves as gay or lesbian. Once again not 
enough data were available to make accurate analyses or statements 
concerning sexual orientation subgroups. Therefore, based on the 
sample's demographic parameters, generalizability of the findings of the 
current study would be Umlted primarily to white, heterosexual, 
undergraduate college students, between the ages of 19-25. One aim of 
subsequent studies might be to attempt to replicate these findings with a 
broader range of age groups, and with a wider array of ethnic groups, and 
individucQs of diverse socioeconomic levels and sexual orientations. 

Another limitation of the current study arose as a result of the 
retrospective research design. Problems with this design include the need 
to rely on the recollections of participants, and also, the possible 
interference of intervening events over the time period explored.. In 
addition, memories may be selective or biased. Participants were Eisked to 
consider breakups occurring over the last twelve months, which might 
not ordtaarlly be viewed a long period of time, but must be considered to 



62 

the framework of the rapldness of changes that often occur in young 
adults during this phase of psychological growth and development. 

A second and perhaps more critical limitation imposed by the 
correlational nature of this design involves its inability to ascertain 
causal connections. Whereas the data show a correlation between self 
loss and depression, there is no way of knowing whether self loss brings 
about depression or vice versa, or whether other unknown factors are at 
work. This study was merely a first step in extending the discipline's 
understanding of the role of self loss in depression. 

In planning for this study, considerable attention was given to 
choosing appropriate instruments to mesisure the constructs of interest 
i.e., self loss, relationship loss, Eind depression. However, there are 
limitations involved in instrumentation nevertheless. For example,with 
respect to the independent measure, the STSS, used to measure self loss, 
is a new instrument that has not been fully validated. It was chosen for 
this study because of its unique measurement contribution In clarifying 
the role of self loss as a possible contributor to women's depression. The 
presence of relationship loss was based on a single item that asked for a 
yes or no response to the question, "Have you experienced the breakup of 
an intimate relationship in the past 12 months?" Although it is generally 
preferable to approach such constructs using a multiple question format, 
a search of the literature revealed no suitable instruments for this 
purpose. Construct vEilidlty may be increased by using multiple items for 
determining the presence or absence of relationship loss. Alternatively, 
participants may become firustrated by their perception of redundancy in 
multiple items asking about relationship loss. 



63 

With reference to the dependent measures, the construct of 
interest was depression. Two measures of depression, the BDI £ind the 
DEQ were used in order to reduce the problem of mono-operation bias. 
The BDI was used based on its established reputation as a general 
screening instrument for depression. The DEQ was chosen for its 
theoretical position which is more traditionally psychoEinalytic; one 
subscale of the DEQ was designed to be especially sensitive to the type of 
depression that occurs in reaction to loss or abandonment. However, 
even with multiple measures of depression, the problem of mono-method 
bias was not eliminated. Both the BDI and the DEQ are self-report 
measures and do not involve a clinician's or rater's direct observations. 
This raises the possibility that correlations found between variables may 
be due to some degree to method variance, rather than true relationships 
among the constructs of interest. 

Streng tlis 

The major strength of the current study can be found in its 
attempt to break new ground. Over the past severEil decades, much 
attention and Interest has focused on the growing discipline of women's 
studies, to which psychologists, psychoanalysts, and other clinicians 
have made significant contributions. However, as is often the case with a 
relatively newer area of investigation, the majority of the work on 
women's psychological development has been theoretical in nature. In an 
effort to add to the small number of empirical studies that build on the 
important work of GiUigan (1982), Jack (1991), and MiUer (1986), the 
current study has been an investigation of a significant piece of 



64 

clinically-relevant theory that re-vlslts the question of the causes of 
women's depression. Although the study is not complete in itself, it is a 
valuable step in the direction of beginning to link empirical testing to 
what has been primarily a conceptual literature. 

A second strength of the study arises out of the cleirity of the 
results. Support for the Jack Model was unambiguous in the first data 
set. Further support for the Jack model came from a replication study 
whose data were collected independently of the first, and showed 
virtually identical results. Again, the Jack Model predictions were 
supported, the Traditional Model and the Potentiation Model predictions 
were not. 

A third strength of the current study is the inclusion of male 
participants. As mentioned above, the inspiration for this study came 
fi-om literature on women, £ind at least some of this work, that of the so- 
caUed "difference feminists," assumes that there are fiindgmiental 
difierences In men and women arising from some combination of nature 
and nurture. One example of these presumed difierences, that has been 
widely written about, is women's stronger relationship orientation. 
Though fi-om the outset this was intended to be a study exploring 
women's depression, an interesting opportunity presented itself to look 
for similarities or differences in men's pattern of responding. In fact, data 
showed very similar patterns of responding in women and men; though, 
overall, men showed lower fi-equencies of self loss and depression. 

In order to strengthen the validity of study results, two depression 
measures were included. This decision was based, in part, on the 
complex and heterogeneous nature of depressive disorders. As a means of 



65 

assessing the potentially wide variations in severity of depression, it weis 
important to meeisure this key construct from more than one perspective. 
The use of instruments from two different theoretical perspectives, 
cognitive and psychodynamic, added further credibility to study results. 

A final strength of the current study Ues in its potential clinical 
value. Whereas much of the psychological literature is only loosely 
relevant to practitioners, these results have immediate import. If 
depression is truly the "common cold" of mental health disorders, the 
concept of self loss, as originated £md defined in the work of Jack, h£is 
far reaching implications for both diagnosis and treatment of a range 
depressive disorders. 

Su ggestions for Future Research 

Because this approach to understanding depression is very new 
and seems promising, there are mj^ad possibilities to pursue. The 
following discussion will touch on only a few of these possibilities and 
will center primarily on studies that might serve as logical successors to 
the study outlined here. 

One very promising avenue to pursue involves designing a 
prospective study to look at shrinkage or expgmsion of self-concept over 
the course of a relationship. The work of Hazel Markus and colleagues 
(Markus & Cross, 1990; Markus & Kitayama,1991; Markus & 
Nurius,1986; Markus & Osyerman,1989) on "possible selves," or the 
multiple roles through which an Individual defines himself or herself, 
would provide a powerful means for tracking changes in identity, self- 
esteem, and well-being, as the relationship progressed. Although this 



66 

type of study will be lengthy £ind more demanding to complete, It would 
Eilso avoid the bi£ising effects of recall Inherent in retrospective designs, 
and would allow for a more detailed ancdysls of the process of self loss 
that occurs In some relationships. 

To establish the external validity of current results that link self 
loss cind depression, it wiU be important to employ a similar design with 
different age groups, ethnic groups, and with individuals from varied 
socioeconomic and educationgd levels. Sedney (1987) has looked at the 
development of identity over the lifespan and her findings suggest that, 
at midlife, there is some "crossing of paths" of men £uid women, with 
women becoming more focused on autonomy and self-expression cind 
men on intimacy and relationships. If this is truly a common pattern, 
there m i g ht be some reversal of the pattern found in younger men and 
women. During the Initial development and testing of the STSS, Jack 
and Dill (1992) did use her instrument with women from differing ethnic 
groups and SEiS levels; however, this diverse sampling should be 
continued as rescEu-ch progresses. Finally, it would also be Interesting to 
discover whether the results compare across individuals of differing 
sexual orientations. 

Yet another viable approach for extending the line of inquiry on 
the relevance of self loss as a precipltEint of women's depression would 
involve the use of a known groups design. Two groups of women would be 
studied, the first would consist of women self-identified as not currently 
seeking a relationship, the second women who are serially 
monogEimous — moving quickly from one similar relationship to the next. 
Different predictions would be made for each group. Though members of 



67 

the first group, women not currently seeking a relationship, would have 
experienced past relationship loss and depression related to self loss, 
their growth process would be toward a stronger sense of identity and 
improved self-esteem. Members of the second group would also have a 
histoiy of self loss and relationship loss, but would be seeking to relieve 
the depression and emptiness by immersing themselves in a new 
relationship. The growth pattern of this group would point more toward 
an addictive process. Methodology in this study could ag£iin involve the 
use of Markus' theory of possible selves which would allow the 
exploration of past current and possible selves in these two distinct 
groups of women (Markus & Wurf,1987). 

A final suggestion for further study would entail investigation into 
the impact of fathering on an adult daughter's general self-evaluation, 
and her tendency to silence herself to maintain a relationship or to avoid 
conflict. This idea comes firom the theoretical works of both Jack (1991) 
and Lemer (1988) who have used clinical data as the basis for 
speculating about how a woman lesims sex-role behavior, including her 
concept of what constitutes a "good woman." While Lemer has focused 
primarily on the broader "family of origin" picture. Jack has shown 
particular interest in the role of the father. She suggests that women 
who grew up in families with a particularly dominating or critical father 
may ultimately be more prone to loss of self in the context of Intimate 
adult relationships. Although a retrospiectlve study comparing women on 
this dimension would have a number of built in limitations, it might 
ultimately prove helpfiil in understanding the integration of sex role into 



68 



identity, and in helping to prevent the type of self loss which is 
correlated with depression. 



Implications for Psychotherapy 

The fundeimental shift in the understanding of depression 
suggested by Jack's work and by the current study, from a focus on 
relationship loss to a focus on self loss, has specied significance for 
clinicians. Given the present incidence and increasing prevalence of 
unipolar forms of depression, especially in young people (Chamey & 
Weissman,1988; Nolen-Hoeksema & Girgus,1994), certain changes in 
practice may be required to accommodate the needs of at least some 
depressed clients — both female and male. As with any good therapy, 
accurate and sensitive assessment is the first step. 

Jack's preliminary study (1991) serves as a valuable reminder of 
the need to listen to cUents attentively and with as few preconceptions 
as possible. Rather them basing treatment Interventions for depression 
only on traditionally accepted factors, a thorough investigation of the 
client's concept of self, primary relationships, f£imily background zmd 
dynamics, and guiding cultural or societal norms is needed. Recurrent 
themes of self-doubt, extreme dep)endency, shame, "hyper -responsibility", 
and /or poor boundaries are signals that the possibility of self loss 
should be explored in greater depth. Questioning the client about gender 
roles In her family of origin and about her current expectations of herself 
as a woman worker, and partner may also prove relevcmt to a fuller 
understanding of current problems. In addition, if formed testing is to be 



69 

included as one cispect of the assessment process, the use of the STSS as 
an indicator of loss of self may prove useful. 

For the female client whose depression may be attributable, at 
least in some measure, to self loss, there are a number of issues to keep 
in mind. First, the primary goal of treatment is to aid the cUent in the 
development of a stronger sense of identity or self. Supporting this 
change may involve a number of different behaviors and interventions, 
foremost among these, the therapist's ability to contact, acknowledge, 
and support, even a partially hidden or extremely fragile sense of self. It 
is imperative that the therapeutic relationship support the client in 
learning to trust herself, and to openly sheire perceptions, feelings, needs 
and abilities (Belenky, Clinchy, Goldberger, & Tarule,1986). The therapist 
should remain sensitive to the centrality of relationships in a woman's 
life, but should not collude with her tendency to silence herself in order 
to maintain important bonds (Schaef,1985). As Lemer (1988,1993) 
cautions, therapists must be aware of their own subtle bieises and of the 
"pathogenic consequences" of rigid gender roles. Her reconmiendation is 
for "reparenting" focused on varied and unique aspects of the client's 
self, an approach that avoids an exclusive focus on soci£illy sanctioned 
forms of self-expression. This reparenting process seems particularfy 
well-suited to depressed women, £is a foundation for rebuilding the self. 

As another step in the recovery process, Bepko and Krestan (1990), 
have emphasized the necessity of helping the client to find a balance 
between work and relationships, connection and solitude, giving and 
receiving. In order to mEiintain this balance of giving to self £ind giving to 
others, they suggest that a conceptual shift must occur within the 



70 

I women herself-a shift from valuing goodness to valuing wholeness. This 

change in self-concept, though clearly an internal process, is 

{ accomplished through therapy that encourages uncensored self- 

expression, creativity and the reintegration of discarded or split-off parts 
of the self. 

Only after a sense of identity and differentiation has been 
sufiBciently nurtured and strengthened in the crucible of the therapeutic 
relationship can the focus of treatment shift away from self and back 
toward the concept of self-in-relationship (Lemer, 1987). In a variation 
on Martin Buber's (1958) work, the woman's relationship to her "selT 
must be an I-Thou relationship before ft is possible to experience this 
same type of sacred relatedness in the interpersonal realm— that is, the 
encounter of whole self with whole self. As Jack has stated, the ultimate 
goal at this stage of healing is for women to "mclude themselves— thefr 
feelings, initiative, values, perspectives— in intimate relationships" (1991, 
p. 191). As long as a woman's shame forces the continued silencing of her 
voice, the possibiftty of creating a truly mutual and healthy relationship 
does not exist. 

In the simplest terms, this new approach to treating women's 
depression would break with tradition by helpmg women identify, value, 
and express their existing skills and abilities. Unlike the more traditional 
models, which assume that women are inherently deficient, this newer 
treatment model assumes women have strengths. Practitioners 
implementing the newer model attempt to build on women's strengths in 
the treatment process, by challenging cultural attitudes and gender -role 



71 



conditioning, and by giving women the opportunity to listen clearly to 
their own voices and dreams. 

The well-known poet May Sarton described her own struggling 
toward selfhood in the followtag excerpt from her poem, "Now I Become 
MyselT: 



Now I become myself. It's taken 

Time, many years and places, 

I have been dissolved 8ind shaken. 

Worn other people's faces, 

Run madly, as if Time were there, 

Terribly old, crying a Wciming, 

"Hurry, you will be dead before — " 

Now to stand still, to be here. 

Feel my own weight and density! . . . 

Now there is time and Time is young. 

0, in this single hour I live 
All of myself and do not move 

1, the pursued, who madly ran. 

Stand still, stand still, and stop the Sun! 

(1991, pp. 28-29) 



APPENDIX A 
INFORMED CONSENT 



The primaiy investigator of this study is Sarah Drew, a doctoral 
student in Counseling Psychology. The purpose of the study is to look at 
the connection between current weU-belng and the resolution of past 
romantic relationships.The study requests that you complete a multi- 
part questionnaire, which wiU require approximately 30 minutes of your 
time. Although it will be most helpftil if you are able to fully complete 
the questionnaire, you may chose not to answer selected questions and 
still receive extra class credit for your participation. Your name will never 
be associated with your answers, so the confidentiality of your responses 
will be protected. 

There is expected to be no risk to you in participating In the study. 
Also, aside from an opportunity to think about your self and the 
relationships you have recentiy been Involved in.there Is probably no 
immediate benefit to you for filling out the questionnaire. The details of 
the extra credit mentioned above wlU be arranged and explained by your 
Instructor You are free to withdraw your consent to participate at any 
time during the course of the study. Please ask any questions you may 
have about tiie project, either now or later. You may reach me through 
the Department of Psychology, 1 14 Psychology Building, 392-0601, Leave 
a message, and I will get back to you as soon as possible. 

In the unlikely event that answering certain of the study questions 
makes you aware of personal problems or concerns, there are several 
campus resources where you may choose to seek help in resohtog these 
problems. The Counseling Center is located in Peabody Hall. Room 301 

72 



73 
(Peabody is part of the Criser Complex). The phone number is 392-1575. 
Student Mental Health Is located at the Inflrmaiy Building, and the 
phone number is 392 -1171. 

I have read and understood the the procedure described above, i agree 
to participate and I have received a copy of this form. 



Name (Please print) 

Signature 

Date 



Witness (P. i. or Assistant) 



Approved for use through April 11, 1995. 



APPENDIX B 
INSTRUCTIONS 



1 ) When aU the materials have been distributed, you should have one 
blue bubble sheet, two copies of the informed consent, and one "Life 
Assessment Questionnaire". 

The questionnaire should consist of nine pages and ninety-one 
questions. Please note that some copies of the questionnah-e are sinele- 
sided and some are double-sided. 

2) Read the informed consent carefully and ask any questions you may 
have. If you decide to participate, please complete and sign one copy i4k 
someone sitting nearby to witiiess your signature. The second copy does 
not need to be filled in. It is yours to keep. 

3) Please write only on the bubble sheet, not on the questionnaire You 
must use a #2 pencil on the bubble sheet. 

4) Since the study is designed in such a way that your privacy is 
prota:ted do net put your name or social security number on the bubble 
Sheet. Instead, look for the number in the upper right comer of the "Life 
Assessment Questionnaire". Write tills number in tiie first four columns 
fu l®l^i^°^ ^^^^ -identification number" (social security number)- 
then bubble in the appropriate numbers. 

5) Notice on the bubble sheets that beginning wltii question #1, possible 
options range fi-om 0-9. Not all questions utiUze the entire scale. Just 
adjust as appropriate. 

6) Also, notice tiiat tiie scale changes fi-om section to section. Please 
^X ^ ^u ^°rf "^ ^^ insti^ctions for each section carefully, and look 
at tiie length and direction of tiie scale. (For example, tiie instructions 
change fi-om page 4 to page 5.) 

II /«? ®'?™®, "IS?^® °^ ^^ questionnaire, there Is an error on question 
86/87. To clarify, use number 86 to bubble in the first dlfilt of your aee 
and number 87 to bubble in tiie second digit of your age!Ask for help if 
needeQ. ^ 

THANKS VERY MUCH FOR YOUR HELP! 



74 



APPENDIX C 
SELECTED ITEMS FROM THE BECK DEPRESSION INVENTORY 

Instructions: The Is a questionnaire. On the questionnaire are groups of 
statements. Please read the entire group of statements in each category 
Then pick out the one statement in that group which best describes the 
way you feel today, that is, right now! Circle the number beside the 
statement you have chosen. If several statements in the group seem to 
appfy equally well, circle each one. 



I do not feel sad 

1 I feel sad 

2 I am sad aU the time and I can't snap out of it 

3 I am so sad or unhappy that I can't stand it 



4. 



I get as much satisfaction out of things as I used to 

1 I don't enjoy things the way I used to 

2 I don't get real satisfaction out of anything anymore 

3 I am dissatisfied or bored with everything 

16. 

I cEm sleep as weD as usual 

1 I don't sleep as well as I used to 

2 I wake up 1-2 hours earlier than usual and I find it hard to get 
back to sleep 

3 I wake up several hours earlier than I used to and cannot get back 
to sleep ** 



75 



APPENDIX D 

SELECTED ITEMS FROM THE DEPENDENCY SCALE OF THE 

DEPRESSIVE EXPERIENCES QUESTIONNAIRE 

Listed below are a number of statements conceraing personal 
characteristics and traits. Read each item and decide whether you agree 
or disagree and to what extent. If you strongly disagree bubble in 
number 6 on your answer sheet; if you strongly agree, bubble in number 
O; if you feel somewhere in between, bubble in one of the numbers 
between and 6. The midpoint, if you are neutral or undecided, is 3. 

12 3 4 5 6 

Strongly Strongly 

^^&^ Disagree 



23. Without support from others who are close to me, I would be 

helpless.* 
34. I find it very difficult to say "No" to the requests of friends. 
40. After a fight with a filend. I must make amends as soon as 

possible. 



* Please note original numbering from the questionnaire used in data 
collection has been retained for purposes of clarity. 



76 



APPENDIX E 
SELECTED ITEMS FOR THE SILENCING THE SELF SCALE 

Please circle the number that best describes how you feel about each of 
the statements listed below. 

12 3 4 

Strongly Somewhat Neither agree Somewhat Strongly 

disagree disagree nor disagree agree agree 

45.* Caring means putting the other person's needs in front of my own. 
50. When my partner's needs and feelings conflict with my own, I 

always state mine clearly. 
63. My partner loves and appreciates me for who I am. 
66. I rarely express my anger at those close to me. 



* Please note original numbering from the questlonnafre used in data 
coUection has been retained for purposes of clarity. 



77 



APPENDIX F 
RELATIONSHIP LOSS QUESTIONNAIRE 

Please bubble In the number next to the correct response. 

74. Have you experienced the breakup of an Intimate relationship In 
the past 12 months? (If you have been through more than breakup in 
this time period, please think about the most recent one as you answer 
questions 74-80.) 

No— Yes— 1 



75. Approximately how many months ago did the breakup occur? 

does not appfy to me — 
l-2mos.— 1 3-4mos.— 2 5-6 mos.— 3 7-8 mos — 4 9-10 
mos— 5 11-12 mos.— 6 

76. Was the breakup: 

does not apply to me — 

123456789 
Your choice A mutual choice Your ex-partner's choice 

77. How important was the relationship to you? 

does not appfy to me — 
1 23456789 
Not at aU Extremely 

78. In thinking back about the relationship, do you feel that at any 
time you "gave up your selT, in order to keep the relationship going? For 
example, did you change your behavior or hide your feelings in an 
attempt to maintain a connection to your partner? 

does not appfy to me — 

12 345678 

never gave up my self always gave up myself 



78 



79 

79. Considering the breakup from your perspective now, do you feel the 
responsibility for the relationship ending was... 

does not apply to me — 

123456789 
Primarily yours About equaUy shared Primarily your ex-partner's 

80. Overall, how satisfied were you with this relationship? 

does not apply to me — 

123456 789 
Not at all Extremely 

81. Are you currently involved in an intimate relationship? 

No— Yes— 1 



82. How important is this current relationship to you? 

does not apply to me — 

123456789 
Not at all Important Extremely important 

83. Overall, how satisfied are you with this current relationship? 

does not apply to me — 

1234 56789 
Not at all satisfied Extremely satisfied 



APPENDIX G 
DEMOGRAPHIC QUESTIONNAIRE 



Please bubble In the number next to the correct response. 

84.* Are you: 

Female — Male — 1 

85. Are you: 

Heterosexual — Homosexual — I Bisexual — 2 

86/87. Your age (Use #84 for the first digit, #85 for the second digit. 

Example: If your age isl9, answer question #84 — 1; question #85 — 9.) 

88. Year in school: 



89. 



Post-Bac. 





Freshperson 


— 1 


Sophomore 


— 2 


Junior 


— 3 


Senior 


— 4 


Grad or Professional Student 


— 5 


Race: 




Anglo or Euro-American 


— 


Afi-o-American 


— 1 


Hispanic American 


— 2 


Asian American 


— 3 



Native American (American Indian) — 4 
Other — 5 

* Please note original numbering fi-om the questionnaire used in data 
collection has been retained for purposes of clarity. 



90. Relationship Status: 

Single — O 

80 



Partnered (but not living together) — 1 81 

Living Together —2 

Married — 3 

Separated — 4 

Divorced — 5 

Widowed —6 

91. Number of Children: 

12 4 5, Etc. 



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BIOGRAPHICAL SKETCH 

Sarah Sevier Drew was bom on January 30, 1957, in Tallahassee, 
Florida, to Edward deBelle Drew and Elizabeth Lanier Drew. She grew up 
in Jacksonville, Florida, and attended Episcopal High School. In 1978, 
Sarah became a Phi Beta Kappa graduate of the University of Florida. 

Following a period of exploration, Sarah began graduate studies in 
counseling psychology and developed a particular interest in object 
relations theories and the psychology of women. Sarah was awarded a 
Master of Science degree in 1991 and completed her internship at the 
University of Maine Counseling Center during 1992-1993. 

Since her return from Maine, Sarah has worked in two 
professional positions, one involving research the other focusing on 
clinical Intervention. She is planning to pursue her interest in treating 
the psychological problems of women. 



88